联合18F-FDG PET/CT代谢参数和内质网应激水平探讨肝细胞癌的临床预后  

Combination of 18F-FDG PET/CT metabolic parameters and endoplasmic reticulum stress levels in predicting prognosis of hepatocellular carcinoma

作　　者：陈晋平 李畅 岳阳 李金岩 郑俊华 焦莹 CHEN Jin-ping;LI Chang;YUE Yang;LI Jin-yan;ZHENG Jun-hua;JIAO Ying(Interventional Catheterization Laboratory,Department of Radiology,Langfang Traditional Chinese Medicine Hospital(Affiliated Traditional Chinese Medicine Hospital of Hebei University of Traditional Chinese Medicine),Langfang 065000,Hebei,China;不详)

机构地区：[1]廊坊市中医医院(河北中医药大学附属中医院)放射科介入导管室,河北廊坊065000 [2]廊坊市中医医院(河北中医药大学附属中医院)放射科,河北廊坊065000 [3]廊坊市中医医院(河北中医药大学附属中医院)检验科,河北廊坊065000 [4]廊坊市广阳区人民医院CT室,河北廊坊065000 [5]廊坊长征医院介入科,河北廊坊065000 [6]廊坊市中医医院(河北中医药大学附属中医院)针灸脑病科,河北廊坊065000

出　　处：《广东医学》2025年第1期96-101,共6页Guangdong Medical Journal

基　　金：河北省2022年度中医药类科研计划课题(2022298)。

摘　　要：目的探讨肝细胞癌(HCC)的C/EBP同源蛋白(CHOP)、萄糖调节蛋白78(GRP78)水平与18F-FDG PET/CT代谢参数之间的关系,并确定CHOP、GRP78水平与代谢参数结合预测HCC患者预后的价值。方法回顾性分析2017—2021年间连续接受根治性手术切除的217例组织学确诊的HCC患者,并根据随访结果将患者被分为幸存组(n=139)和死亡组(n=78)。记录了患者的临床病理数据和总生存期,对肿瘤组织进行免疫组织化学分析,以检测内质网应激相关标志物(CHOP、GRP78)的表达。通过PET/CT定量评估最大FDG摄取(SUVmax)。结果与幸存组相比,死亡组高血压例数、CHOP阳性表达例数、SUVmax水平显著增加(P<0.05)。CHOP阳性表达患者的SUVmax水平显著高于阴性表达患者(P<0.05)。Cox回归分析显示,SUVmax(HR=1.198,95%CI=1.110~1.294,P<0.001)和CHOP(HR=9.179,95%CI=3.610~23.341,P<0.001)是HCC根治性肝切除术患者总生存期的独立影响因素。受试者操作特征(ROC)曲线分析显示,SUVmax与CHOP组合时的AUC为0.904(95%CI:0.858~0.950),敏感度为92.3%,特异度为88.5%。Kaplan-Meier分析显示,高SUVmax(≥3.9)和CHOP阳性组的生存时间最低[(35.8±1.1)个月],低SUVmax(<3.9)和CHOP阴性组的生存时间最高[(56.9±2.9)个月],三组之间的存活时间差异有统计学意义(Log-rank=4.810,P=0.045)。结论接受根治性肝切除术的HCC患者肿瘤微环境中CHOP阳性表达和高SUVmax与患者总生存率低显著相关,二者均可作为HCC患者预后的独立影响因素。Objective To investigate the relationship between endoplasmic reticulum stress markers[C/EBP homologous protein(CHOP)and glucose-regulated protein 78(GRP78)]and metabolic parameters derived from 18F-FDG PET/CT in hepatocellular carcinoma(HCC),and to evaluate the combined predictive value of CHOP,GRP78,and metabolic parameters for HCC prognosis.Methods A retrospective analysis was conducted on 217 patients with histologically confirmed HCC who underwent curative surgical resection between 2017 and 2021.Patients were divided into a survival group(n=139)and a mortality group(n=78)based on follow-up outcomes.Clinicopathological data and overall survival(OS)were recorded.Immunohistochemistry was used to detect CHOP and GRP78 expression in tumor tissues.Tumor maximum standardized uptake value(SUVmax)was assessed using PET/CT.Results Compared with the survival group,the mortality group had significantly higher incidences of hypertension,CHOP-positive expression,and SUVmax levels(P<0.05).Patients with CHOP-positive expression had significantly higher SUVmax levels than CHOP-negative patients(P<0.05).Cox regression analysis revealed that SUVmax(HR=1.198,95%CI=1.110-1.294,P<0.001)and CHOP(HR=9.179,95%CI=3.610-23.341,P<0.001)were independent prognostic factors for OS in HCC patients.ROC analysis demonstrated that the combination of SUVmax and CHOP yielded an AUC of 0.904(95%CI=0.858-0.950),with a sensitivity of 92.3%and a specificity of 88.5%.Kaplan-Meier survival analysis showed that patients with high SUVmax(≥3.9)and CHOP-positive expression had the shortest survival time(35.8±1.1 months),while those with low SUVmax(<3.9)and CHOP-negative expression had the longest survival time(56.9±2.9 months),with significant differences between the groups(Log-rank=4.810,P=0.045).Conclusion In HCC patients undergoing curative liver resection,positive CHOP expression in the tumor microenvironment and high SUVmax were significantly associated with lower OS.Both are independent prognostic factors for HCC and provide valuable insights

关 键 词：PET/CT 内质网应激 肝细胞癌 免疫组织化学 预后 

分 类 号：R735.7[医药卫生—肿瘤] R-33[医药卫生—临床医学]