18F-FDG PET/CT代谢参数对局部进展期和晚期直肠癌原发灶的诊断价值

目的:探讨直肠癌原发灶18F-FDG PET/CT代谢参数在直肠癌局部进展期与晚期中的诊断价值。方法:回顾性分析从2008年1月至2016年4月在哈尔滨医科大学附属肿瘤医院进行诊治的直肠癌患者，于术前和其他治疗前行18F-FDG PET/CT检查，检查后两周内均进行手术的患者60例，其中局部进展期组38例，晚期组22例。记录患者年龄、性别、病理类型、组织学类型等临床病理参数及最大标准化摄取值（maximum standardized uptake value，SUVmax）、肿瘤代谢体积（metabolic tumor volume，MTV）和总糖酵解量（total lesion glycolysis，TLG）等代谢参数。先进行独立样本t检验计算以上各因素与不同分组之间的关系；分别绘制SUVmax、MTV、TLG诊断直肠癌局部进展期组和晚期组效能的ROC曲线，得到相应的曲线下面积、最佳截断点、以及相应的灵敏度、特异性。结果:局部进展期组和晚期组之间的年龄、性别、病理类型、组织学类型、SUVmax无统计学差异（P＞0.05），而两组之间的MTV、TLG存在统计学差异（P＜0.05）。ROC曲线统计结果显示，MTV、TLG 和SUVmax的最佳截断点分别为13.18、152.06和15.80，曲线下面积（AUC）分别为0.802、0.804、0.575；诊断两组的灵敏度分别为77.3%、63.6%、54.5%；特异性分别为76.3%、81.6%、57.9%。结论:直肠癌原发灶的18F-FDG PET/CT代谢参数MTV和TLG在诊断局部进展期和晚期方面明显优于SUVmax；可以为进一步临床精准分期及治疗提供帮助。

The diagnostic value of 18F-FDG and PET/CT metabolic parameters in local advanced stage and late stage of rectal cancer

Objective:To investigate the diagnostic value of 18F-FDG and PET/CT metabolic parameters in local advanced stage and late stage of rectal cancer.Methods:A retrospective analysis was made on the diagnosis and treatment of rectal cancer in Harbin Medical University Cancer Hospital from January 2008 to April 2016,who did 18F-FDG PET/CT examination before operation and other treatment,and surgery in two weeks in 60 cases,including 38 cases in the local advanced group and the other in the late stage group(n=22).The clinical pathological parameters such as age,gender,pathological type and histological type and maximum standardized uptake value（SUVmax），metabolic tumor volume（MTV）and total lesion glycolysis（TLG）were recorded.The independent sample t test was used to calculate the relationship between the above factors and different groups.The ROC curves of SUVmax,MTV,and TLG were drawed to use as diagnostic efficacy in locally advanced group and late stages group of rectal cancer.And the area under the curve,the optimal cut-off point,and the corresponding sensitivity and specificity were obtained.Results:The results showed that there was no significant difference in age,gender,lesion location,pathological type,histological type and SUVmax between the patients with locally advanced group and late stage group（P＞0.05）.And there was statistical difference between the two groups of MTV and TLG（P＜0.05）.The ROC curve showed that the best cut-off points of MTV,TLG and SUVmax were 13.18，152.06 and 15.80,respectively.The area under the curve(AUC) was 0.802，0.804 and 0.575,respectively.The sensitivity of the diagnosis was 77.3%，63.6% and 54.5%,respectively,and the specificity was 76.3%,81.6%,and 57.9%,respectively.Conclusion:The 18F-FDG and PET/CT metabolic parameters MTV and TLG in the primary foci of rectal cancer are significantly better than those of SUVmax in the diagnosis of local advanced and late stages,which can help further clinical accurate staging and treatment.