~(18)F-FDG PET/CT代谢参数和肌肉减少症在食管鳞癌中的预后价值  

Prognostic value of ^(18)F-FDG PET/CT metabolic parameters and sarcopenia in esophageal squamous carcinoma

作　　者：周敏[1] 刘辉 ZHOU Min;LIU Hui(Department of Nuclear Medicine,Yancheng No.1 People's pital,Yancheng First Hospital Affiliated of Nanjing University Medical College,Yancheng 224000,Jiangsu,China;Department of Radiotherapy,Yancheng No.1 People's pital,Yancheng First Hospital Affiliated of Nanjing University Medical College,Yancheng 224000,Jiangsu,China)

机构地区：[1]南京大学医学院附属盐城第一医院,盐城市第一人民医院核医学科,江苏盐城224006 [2]南京大学医学院附属盐城第一医院,盐城市第一人民医院放疗科,江苏盐城224006

出　　处：《生物医学工程与临床》2024年第4期479-484,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的旨在评估治疗前18-氟-脱氧葡萄糖(~(18)F-FDG)正电子发射体层摄影术/计算机体层摄影术(PET/CT)代谢参数和肌肉减少症在食管鳞癌患者危险度分层中的价值。方法选择91例食管鳞癌患者,其中男性69例,女性22例;年龄43~85岁,平均年龄67岁;TNM分期,Ⅰ~Ⅱ期37例(40.66%),Ⅲ~Ⅳ期54例(59.34%);身体质量指数(BMI)<18.5 kg/m^(2)19例,18.5~24.9 kg/m^(2)55例,25.0~29.9 kg/m^(2)14例,≥30 kg/m^(2)3例。通过测量PET/CT的CT部分第3腰椎水平骨骼肌指数来判断肌肉减少症。~(18)F-FDG PET/CT代谢参数包括原发性肿瘤的最大标准化摄取值(SUV_(max))、平均标准化摄取值(SUV_(mean))、病灶的代谢体积(MTV)及糖酵解总量(TLG)。利用Cox回归模型来确定与生存率相关的变量。结果91例患者中有42例(46.2%)被诊断为肌肉减少症。中位随访时间18个月(1~69个月)后,41.76%(38/91)患者出现疾病进展,30.77%(28/91)患者死亡,中位无进展生存(PFS)和总生存(OS)分别为15个月和18个月。肿瘤临床分期、BMI、淋巴血管侵犯(LVI)、骨骼肌指数(SMI)和原发肿瘤的MTV是预测PFS和OS的重要指标,被用来构建列线图,其在评估食管癌患者生存预后方面表现出卓越的预测能力。多因素分析中,MTV[PFS:P=0.025,风险比(HR)=3.388,95%可信区间(CI)=1.168~9.831;OS:P=0.033,HR=4.882,95%CI=1.135~20.986]、BMI(PFS:P=0.001,HR=2.296,95%CI=1.423~3.702;OS:P=0.021,HR=1.952,95%CI=1.104~3.451)和肌肉减少症(PFS:P=0.001,HR=3.640,95%CI=1.692~7.830;OS:P=0.002,HR=4.237,95%CI=1.715~10.465)是影响PFS和OS预后的独立预后因素。与非肌肉减少症患者相比,肌肉减少症患者具有较差的PFS和OS。同样,MTV>5.33、低BMI患者的PFS和OS较差。结论基线~(18)F-FDG PET/CT代谢参数MTV、BMI及肌肉减少症是食管鳞癌患者的独立预后因素。高MTV水平、低BMI及肌肉减少症与不良的生存率相关。Objective To evaluate the value of pretreatment^(18)F-fluorodeoxyglucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT) metabolic parameters and sarcopenia in risk stratification of patients with esophageal squamous carcinoma.Methods A total of 91 patients with esophageal squamous carcinoma were enrolled,which included 69 males and 22 females,aged 43-85 years old with mean age of 67 years old.According to TNM staging,there were 37 cases(40.66%) of stageⅠ-Ⅱand 54 cases(59.34%) of stageⅢ-Ⅳ.Body mass index(BMI)<18.5 kg/m^(2)in 19 cases,18.5-24.9 kg/m^(2)in55 cases,25.0-29.9 kg/m^(2)in 14 cases,≥30 kg/m^(2)in 3 cases.Sarcopenia was determined by measuring the skeletal muscle index of the third lumbar spine on PET/CT.The metabolic parameters of~(18)F-FDG PET/CT included the maximum standardized uptake value(SUV_(max)),mean standardized uptake value(SUV_(mean)),metabolic tumor volume(MTV),and total lesion glycolysis(TLG) of primary tumor.The Cox regression models were utilized to identify variables associated with survival.Results Among the 91 patients,42(46.2%) were diagnosed with sarcopenia.After median follow-up of 18 months(1-69 months),41.76%(38/91) patients showed disease progression,and 30.77%(28/91) patients died,the median progression-free survival(PFS) and overall survival(OS) were 15 months and 18 months,respectively.Tumor clinical stage,BMI,lymphatic vascular in vasion(LVI),skeletal muscle index(SMI) and primary tumor MTV were important indicators for predicting PFS and OS,which were used to construct nomogram and showed excellent predictive ability in evaluating the survival and prognosis of patients with esophageal cancer.In multivariate analysis,MTV[PFS:P=0.025,hazard ratio(HR)=3.388,95%confidence interval(CI)=1.168-9.831;OS:P=0.033,HR=4.882,95%CI=1.135-20.986],BMI (PFS:P=0.001,HR=2.296,95%CI=1.423-3.702;OS:P=0.021,HR=1.952,95%CI=1.104-3.451) and sarcopenia (PFS:P=0.001,HR=3.640,95%CI=1.692-7.830;OS:P=0.002,HR=4.237,95%CI=1.715-10.465) were independent prognostic factors f

关 键 词：食管癌 肌肉减少症 ~(18)F-FDG PET/CT 代谢体积(MTV) 预后 

分 类 号：R735.1[医药卫生—肿瘤] R685[医药卫生—临床医学]