18F-FDG PET/CT相关参数预测结直肠癌切除术预后的价值

目的 探究18F-FDG PET/CT相关参数对结直肠癌（CRC）根治术后患者的无病生存时间（DFS）和总生存时间（OS）的预后预测价值。 方法 回顾性分析2011年11月至2016年10月行18F-FDG PET/CT检查的132例CRC患者临床资料，其中男性93例、女性39例，中位年龄63岁。使用18F-FDG PET/CT的最大标准化摄取值（SUV_max）=2.5及SUV_max的20%、30%、40%、50%等作为不同阈值，计算不同阈值的平均标准化摄取值（SUV_mean）、肿瘤代谢体积（MTV）和病灶糖酵解总量（TLG），并预测CRC患者根治术后的DFS和OS。通过受试者工作特征（ROC）曲线获得18F-FDG PET/CT相关参数的曲线下面积，并获得DFS的最佳阈值。生存分析采用Kaplan-Meier法进行，单因素分析采用Log-rank检验，多因素分析采用COX比例风险模型。 结果 ROC曲线分析预测DFS最佳阈值分别为SUV_max=19.36、MTV=22.64 cm3、TLG=117.78 g、TLG_20%=129.74 g、TLG_30%=107.05 g、TLG_40%=73.22 g和TLG_50%=56.13 g。DFS预后的单因素分析结果显示，癌胚抗原（CEA）、糖类抗原（CA）19-9、淋巴结转移、临床分期、化疗、SUV_max、MTV、TLG、TLG_20%、TLG_30%、TLG_40%、TLG_50%是CRC患者DFS的影响因素；多因素分析结果显示，SUV_max（95%CI:1.882~5.815，OR=3.308，P=0.000）、临床分期（95%CI:1.226~3.819，OR=2.164，P=0.008）和CA19-9（95%CI:1.182~3.724，OR=2.098，P=0.011）是影响CRC患者术后DFS的独立危险因素。OS预后的单因素分析结果显示，CEA、CA19-9、组织学类型、SUV_max、MTV、TLG、TLG_20%、TLG_30%、TLG_40%、TLG_50%是CRC患者OS的影响因素；多因素分析结果显示，SUV_max（95%CI:1.129~6.624，OR=2.735，P=0.026）、TLG_50%（95%CI:1.640~19.801，OR=5.699，P=0.006）和CA19-9（95%CI:1.868~11.084，OR=4.550，P=0.001）是影响CRC患者术后OS的独立危险因素。 结论 18F-FDG PET/CT相关参数SUV_max、TLG_50%可以用于评估CRC患者的预后，参数值越大，预后越差。

18F-FDG PET/CT related parameters can predict postoperative prognosis of colorectal cancer

Objective To explore the clinical value of 18F-FDG PET/CT-related parameters for the prediction of tumor disease-free survival time (DFS) and overall survival time (OS) after the radical resection of colorectal cancer (CRC). Methods Retrospective analysis was conducted on 132 patients (93 males and 39 females; median age, 63 years) with CRC who underwent 18F-FDG PET/CT examination between November 2011 and October 2016. The 18F-FDG PET/CT-related parameters were as follows: SUV_max=2.5 (20%, 30%, 40%, and 50% of SUV_max were used as different thresholds); SUV_mean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of different thresholds; and DFS and OS of CRC patients after radical resection. The receiver-operating characteristic (ROC) curve was used in the measurement of the area under curve of 18F-FDG PET/CT-related parameters and the optimal DFS cutoff value. Survival analysis was performed with the Kaplan-Meier method. Univariate and multivariate analyses were performed with Log-rank test and the COX proportional hazards model, respectively. Results The ROC curve predicted the DFS cut off value, and SUV_max=19.36, MTV= 22.64 cm3, TLG= 117.78 g, TLG_20% = 129.74 g, TLG_30% = 107.05 g, TLG_40% = 73.22 g, and TLG_50% = 56.13 g. DFS univariate analysis showed that CEA, CA19-9, lymph node metastasis, clinical stage, chemotherapy, SUV_max, MTV, TLG, TLG_20%, TLG_30%, TLG_40%, and TLG_50% were the factors influencing postoperative DFS. Multivariate analysis showed that SUV_max (95%CI: 1.882–5.815, OR= 3.308, P<0.000), clinical stage (95%CI: 1.226–3.819, OR = 2.164, P=0.008), and CA19-9 (95%CI: 1.182–3.724, OR=2.098, P= 0.011) were independent risk factors for postoperative DFS. The survival analysis of OS univariate analysis showed that CEA, CA19-9, histological type, SUV_max, MTV, TLG, TLG_20%, TLG_30%, TLG_40%, and TLG_50% were the factors influencing postoperative OS. Furthermore, SUV_max (95%CI: 1.129–6.624, OR=2.735, P=0.026), TLG_50% (95%CI: 1.640–19.801, OR=5.699, P=0.006), and CA19-9 ( 95%CI: 1.868–11.084, OR=4.550, P=0.001) were the independent risk factors for postoperative OS. Conclusion 18F-FDG PET/CT-related parameters SUV_max and TLG_50% can predict the prognosis of patients with CRC; the higher the parameter values are, the worse the prognoses are.