术前^(18)F-FDG PET/CT代谢参数模型预测肝细胞癌肝移植术后复发的价值  

Value of preoperative PET/CT metabolic parameter-based model in predicting the recurrence of hepatocellular carcinoma after liver transplantation

作　　者：胡欣 林方增 林晓洁 文芳 王晓燕[1] HU Xin;LIN Fangzeng;LIN Xiaojie;WEN Fang;WANG Xiaoyan(Department of Nuclear Medicine,The First Affiliated Hospital of Sun Yat-sen University,Guangdong,510080,China)

机构地区：[1]中山大学附属第一医院核医学科,广东广州510080

出　　处：《影像诊断与介入放射学》2023年第5期359-366,共8页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨应用术前^(18)F-FDG PET/CT代谢参数的模型预测肝细胞癌(HCC)肝移植(LT)术后复发中的价值。方法回顾性分析了86 LT术前接受^(18)F-FDG PET/CT检查的HCC患者的临床、病理和影像学资料,并提取^(18)F-FDG PET/CT图像中的代谢参数。通过Cox回归分析筛选出与HCC患者LT术后复发相关的危险因素,将具有统计学意义的因素组合建立PET/CT代谢参数模型,同时建立米兰标准模型、加州大学旧金山分校(UCSF)标准模型和杭州标准模型。计算各模型的一致性指数(C-index)并进行比较。使用Kaplan-Meier曲线及决策曲线分析(DCA)评估不同模型判别不同HCC患者复发风险的能力和临床实用性。结果研究纳入的86例患者中,41例(47.7%)LT术后复发。术前甲胎蛋白(AFP)(P<0.001)、肿瘤代谢体积(MTV)(P=0.020)、病变总糖酵解(TLG)(P=0.016)是预测LT术后复发的危险因素。组合以上因素建立的PET/CT代谢参数模型的C-index为0.689,高于现有通用标准模型。结论结合AFP和PET/CT代谢参数的综合模型对HCC患者LT术后复发具有较高的预测价值。Objective To explore the value of a preoperative ^(18)F-FDG PET/CT metabolic parameter-based model in predicting recurrence of hepatocellular carcinoma(HCC)after liver transplantation(LT).Methods Clinical,pathological,and ^(18)F-FDG PET/CT imaging characteristics of 86 patients with confirmed HCC before LT were retrospectively analyzed.Metabolic parameters were extracted from the ^(18)F-FDG PET/CT images.Cox regression analysis was applied to determine the risk factors associated with HCC recurrence.Statistically significant factors were all integrated to build the PET/CT metabolic parameter-based model,Milan standard model,the University of California,San Francisco standard model,and Hangzhou standard model.The concordance index(C-index)of each model was calculated and compared.Kaplan-Meier curves were plotted to reveal the discrimination ability of models.Clinical practicality of the final model was assessed by decision curve analysis(DCA).Results HCC recurred in 47.7%(41/86).Preoperative alpha-fetoprotein(AFP)level(P<0.001),metabolic tumor volume(MTV,P=0.020),and total lesion glycolysis(TLG,P=0.016)were identified as risk factors for recurrence.The PET/CT metabolic parameter-based model achieved the highest C-index of 0.689 and distinguished LT candidates with different recurrence risk better than other models based on current common criteria.Conclusion The model combining AFP and ^(18)F-FDG PET/CT metabolic parameters shows good efficacy in predicting the recurrence of HCC patients after LT.

关 键 词：肝细胞癌 肝移植 正电子发射型计算机断层显像 无复发生存期 

分 类 号：R735.7[医药卫生—肿瘤] R817.4[医药卫生—临床医学]