^(18)F-FDG PET/CT代谢参数对结直肠癌寡转移行根治性治疗患者预后的预测价值  

Value of ^(18)F-FDG PET/CT metabolic parameters in predicting the prognosis of patients with oligometastatic colorectal cancer after radical treatment

作　　者：朱振华 赵霞[3] 李秉营 李海文 孙虎魁 ZHU Zhenhua;ZHAO Xia;LI Bingying;LI Haiwen;SUN Hukui(Department of Radiology,Zibo Hospital of Shandong Yiyang Health Group,Zibo 255120,China)

机构地区：[1]山东颐养健康集团淄博医院影像科,山东淄博255120 [2]青岛大学医疗集团淄博医院影像科 [3]山东中医药大学附属医院 [4]淄博市中心医院核医学和放射治疗科

出　　处：《精准医学杂志》2025年第2期148-152,共5页Journal of Precision Medicine

基　　金：国家自然科学基金青年基金项目(81601535);青岛大学医疗集团科研项目(YLJT20242008)。

摘　　要：目的探讨^(18)F-FDG PET/CT代谢参数对结直肠癌寡转移患者根治性治疗后预后的预测价值。方法回顾性分析82例经病理证实且经根治性治疗后的结直肠癌寡转移患者的临床资料,根据患者随访期间是否发生进展将所有患者分为进展组(49例)和未进展组(33例),收集患者术前^(18)F-FDG PET/CT代谢参数,以及患者的临床分期、原发灶位置、分化程度、神经侵犯情况、脉管癌栓情况、术前CEA值等临床特征数据。分别采用Kaplan-Meier生存分析、Schoenfeld残差法对分类变量和连续变量进行比例风险假定判断;根据变量类型及是否满足比例风险假定,分别采用log-rank检验、单因素Cox回归分析、Cox依时协变量回归模型进行单因素分析,将上述分析中对患者预后有显著影响的因素纳入含依时协变量Cox回归模型进行多因素分析,并将独立影响因素进行二元logistc回归分析,绘制受试者工作特征(ROC)曲线并分析独立影响因素的预测效能。结果单因素Cox回归分析结果显示,临床分期(χ^(2)=11.538,P<0.05)、术前MTV值(HR=1.023,95%CI=1.012~1.034,P<0.05)及TLG值(HR=1.002,95%CI=1.001~1.003,P<0.05)在组间差异具有显著性。Cox依时协变量回归模型多因素分析结果显示,临床分期(HR=2.636,95%CI=1.476~4.780,P<0.05)、术前MTV值(HR=1.024,95%CI=1.013~1.035,P<0.05)是结直肠癌寡转移患者根治性治疗后预后的独立影响因素。ROC曲线分析结果显示,术前MTV值预测结直肠癌寡转移患者根治性治疗后预后最佳阈值为13.94 cm 3,AUC为0.738(95%CI=0.627~0.848,P<0.05),灵敏度和特异度分别为75.8%和63.3%。术前MTV值和临床分期联合预测时,AUC为0.801,灵敏度为81.6%。结论临床分期越晚、术前MTV值越高的结直肠癌寡转移患者根治性治疗后的预后越差。Objective To investigate the value of ^(18)F-FDG PET/CT metabolic parameters in predicting the prognosis of patients with oligometastatic colorectal cancer(CRC)after radical treatment.Methods A retrospective analysis was performed for the clinical data of 82 patients who had pathologically confirmed oligometastatic CRC and underwent radical treatment,and according to the presence or absence or progression during follow-up,they were divided into progression group with 49 patients and non-progression group with 33 patients.Preoperative ^(18)F-FDG PET/CT metabolic parameters were collected from all patients,as well as clinical features including clinical stage,primary tumor location,degree of tumor differentiation,neurovascular invasion,vascular tumor thrombus,and preoperative carcinoembryonic antigen.Kaplan-Meier survival analysis and Schoenfeld residual ana-lysis were used to assess the proportional hazards assumptions of categorical variables and continuous variables.According to the type of variables and the results of proportional hazards assumptions,the log-rank test,univariate Cox regression analysis,and Cox regression model with time-dependent covariates were used to perform the univariate analysis.The factors with a significant impact on prognosis were included in the Cox regression model with time-dependent covariates for multivariate analysis,and a binary logistic regression analysis was performed for independent influencing factors.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive performance of independent influencing factors.Results The univariate Cox regression analysis showed that there were significant differences between the two groups in clinical stage(χ^(2)=11.538,P<0.05),preoperative MTV(HR=1.023,95%CI=1.012-1.034,P<0.05),and TLG(HR=1.002,95%CI=1.001-1.003,P<0.05).The multivariate Cox regression analysis with time-dependent covariates showed that clinical stage(HR=2.636,95%CI=1.476-4.780,P<0.05)and preoperative MTV(HR=1.024,95%CI=1.013-1.035,P<0.05)were indep

关 键 词：结直肠肿瘤 肿瘤转移 氟脱氧葡萄糖F18 正电子发射断层显像计算机体层摄影术 预后 影响因素分析 

分 类 号：R735.34[医药卫生—肿瘤]