90例舌癌术后患者18F-FDG符合线路显像研究及预后分析

目的 探讨舌癌术后患者的18F-FDG符合线路显像结果并分析舌癌预后的危险因素.方法 90例行手术切除并经病理诊断为舌癌的患者均在手术治疗≥3月之后行18F-FDG符合线路显像,计算符合线路显像对舌癌术后复发和（或）转移的诊断效能.舌癌预后分析中,采用Kaplan-Meier法计算生存率,Logrank检验法进行单因素预后分析,Cox回归模型及逐步回归向后最大似然法进行多因素预后分析.结果 18F-FDG符合线路显像对舌癌术后复发和（或）转移的诊断灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为95.1％ （58/61）、69.0％（20/29）、86.7％（78/90）、86.6％（58/67）、87.0％（20/23）.在34例舌癌术后复发患者中,复发部位以舌体（32.4％,11/34）最为多见.在40例舌癌术后转移患者中,主要为淋巴结转移（65.1％,41/63）,其次为肺转移（27.0％,17/63）、骨骼（6.3％,4/63）转移.90例舌癌术后患者的总体1年生存率为82.5％,3年生存率为54.7％,5年生存率为52.9％.单因素预后分析显示,舌癌术后生存率与TNM临床分期、病理分化等级、早期淋巴结转移、局部复发及远处转移相关（χ2=26.282、9.629、9.629、9.442和4.928,P均＜0.05）.多因素预后分析显示,舌癌术后的预后危险因素为TNM临床分期、病理分化等级、早期淋巴结转移、局部复发、延迟淋巴结转移及远处转移（Wald值=9.855、6.585、5.042、6.271、4.354和5.134,P均＜0.05）.结论 18F-FDG符合线路显像在舌癌术后监测及预后评估中为一种有效的无创性检查方法.

Study on 18F-FDG Coincidence Imaging and Prognosis Prediction in 90 Postoperative Patients of Tongue Cancer

Objective To analyze the results of 18F-fluorodeoxyglucose （18 F-FDG） coincidence imaging and prognosis in postoperative patients of tongue cancer. Methods 18 F-FDG coincidence imaging was performed in 90 patients with pathologically confirmed tongue cancer no less than 3 months after surgical therapy. The diagnostic ability of coincidence imaging in detecting recurrence and/or metastasis of tongue cancer was assessed. Survival rates were calculated by Kaplan-Meier method. Logrank test was used in univariate prognostic analysis. Cox regression model and stepwise regression backward maximum likelihood method were used in multivariate prognostic analysis. Results The sensitivity, specificity, accuracy, positive （PPV） and negative predictive values （NPV） of 18 F-FDG coincidence imaging for detecting recurrence and/or metastasis of tongue cancer were 95.1% （58/61） ,69.0% （20/29） ,86.7% （78/90） ,86.6% （58/67） and 87.0% （20/ 23） ,respectively. Of the 34 patients with recurrenee of tongue cancer,tongue body （32.4%, 11/34） was the most frequent recurrent locations. Of the 40 patients with metastasis of tongue cancer,lymph node （65.1% ,41/ 63） was the main site of metastases. Then lung （27.0% ,17/63） and bone （6.3% ,4/63） followed. The 1-, 3-and 5-year overall survival rates of 90 postoperative tongue cancer patients were 82. 5%, 54. 7% and 52.9%, respectively. Univariate analysis showed that TNM stage, degree of histological differentiation, early lymphatic metastasis, local recurrence and distant metastasis were significantly relevant to prognosis of tongue cancer （χ2 = 26. 282,9. 629,9. 629,9. 442,4. 928, respectively, all P 〈 0.05 ）. Multivariate analysis indicatedthat TNM stage, degree of histological differentiation, early lymphatic metastasis, local recurrence, delayed lymphatic metastasis and distant metastasis were independent risk factors influencing prognosis （Wald value = 9. 855,6. 585,5. 042,6. 271,4. 354,5. 134, respectively, all P 〈 0.05 ）. Conclu