序贯18F-FDG PET/CT显像在非手术治疗食管癌同步放化疗疗效预测中的价值
서관18F-FDG PET/CT현상재비수술치료식관암동보방화료료효예측중적개치
Predictive value of sequential 18F-FDG PET/CT scan in concurrent chemoradiotherapy of non-surgical esophageal carcinoma
  • 万方数据
    中华核医学与分子影像杂志 중화핵의학여분자영상잡지
    Chinese Journal of Nuclear Medicine and Molecular Imaging
    2013年 6期 405-411 ,共7页

    李夷民%林勤%王丽琛%孙龙%戴明明%罗作明%郑华%赵龙%吴华

    리이민%림근%왕려침%손룡%대명명%라작명%정화%조룡%오화

    食管肿瘤%放射疗法%药物疗法%体层摄影术,发射型计算机%体层摄影术,X线计算机%脱氧葡萄糖 食管腫瘤%放射療法%藥物療法%體層攝影術,髮射型計算機%體層攝影術,X線計算機%脫氧葡萄糖
    식관종류%방사요법%약물요법%체층섭영술,발사형계산궤%체층섭영술,X선계산궤%탈양포도당
    Esophageal neoplasms%Radiotherapy%Drug therapy%Tomography,emission-computed%Tomography,X-ray computed%Deoxyglucose
    目的 利用序贯18F-FDG PET/CT显像观察非手术食管癌同步放化疗(CCRT)中肿瘤代谢变化规律,探讨其预测价值.方法 2009年5月至2011年10月前瞻性入组并经病理证实、拟行CCRT的28例食管鳞状细胞癌(简称鳞癌)患者,在CCRT前、放疗总剂量(DT)达50 Gy时、DT达60 Gy时、CCRT后1个月进行18F-FDG PET/CT显像;记录4次显像的食管放射性异常浓聚区SUVmax,分别记为SUVmax1～4.采用软件自动勾画放疗前的大于40％ SUVmax的原发灶及邻近淋巴结,计算两者体积和,命名为MTV.CCRT后对患者进行定期随访,中位随访时间为18.5个月,记录无进展生存期(PFS)、无复发生存期(RFS)及总生存期(OS).将患者按有无疾病进展、有无复发及有无死亡各自进行分组,采用Mann-Whitney u检验比较组间SUVmax和SUVmax变化率的差异.用ROC曲线计算MTV等参数预测生存的最优阈值,并采用Kaplan-Meier及Cox回归分析进行生存分析.结果 截至随访结束,28例患者中,进展19例,无进展9例;复发17例,无复发11例;死亡15例,生存13例.有无复发组间SUVmax2(7.4±3.3与4.8±2.5)及SUVmax3(5.5±2.1与3.8±2.1)差异均有统计学意义(u=46、47,均P＜0.05).SUVmax4在有无进展组间(5.3±3.9与2.4±1.7)、有无复发组间(5.6±4.0与2.4±1.5)和有无死亡组间(5.8±4.2与2.6±1.5)差异均有统计学意义(u=31、26、29,均P＜0.05);△R14[(SUVmax1-SUVmax4)/SUVmax1]的差异也如此(0.49±0.57与0.76±0.22、0.48±0.60与0.73±0.22、0.44±0.64与0.73±0.19;u=39、50、53,均P＜0.05).28例患者治疗前MTV均值为19.3 ml,ROC曲线计算的最优预测阈值为12.4 ml(P＜0.01),治疗前MTV≥12.4 ml者PFS较＜12.4 ml者短,中位值分别为13.1个月及31.4个月(x2=9.0,P＜0.05).△R14预测PFS及OS的最佳阈值为0.75.Cox回归多因素生存分析示,MTV是影响PFS及RFS的独立预后因素,Wald值依次为10.80、10.30,风险比依次为1.13、1.14.结论 CCRT前的MTV是预测非手术食管癌CCRT疗效的独立预后因素.SUVmax2～4对治疗后的RFS可能有一定的预测作用.SUVmax4减少小于75％的患者PFS、RFS、OS均较差.
    목적 이용서관18F-FDG PET/CT현상관찰비수술식관암동보방화료(CCRT)중종류대사변화규률,탐토기예측개치.방법 2009년5월지2011년10월전첨성입조병경병리증실、의행CCRT적28례식관린상세포암(간칭린암)환자,재CCRT전、방료총제량(DT)체50 Gy시、DT체60 Gy시、CCRT후1개월진행18F-FDG PET/CT현상;기록4차현상적식관방사성이상농취구SUVmax,분별기위SUVmax1～4.채용연건자동구화방료전적대우40％ SUVmax적원발조급린근림파결,계산량자체적화,명명위MTV.CCRT후대환자진행정기수방,중위수방시간위18.5개월,기록무진전생존기(PFS)、무복발생존기(RFS)급총생존기(OS).장환자안유무질병진전、유무복발급유무사망각자진행분조,채용Mann-Whitney u검험비교조간SUVmax화SUVmax변화솔적차이.용ROC곡선계산MTV등삼수예측생존적최우역치,병채용Kaplan-Meier급Cox회귀분석진행생존분석.결과 절지수방결속,28례환자중,진전19례,무진전9례;복발17례,무복발11례;사망15례,생존13례.유무복발조간SUVmax2(7.4±3.3여4.8±2.5)급SUVmax3(5.5±2.1여3.8±2.1)차이균유통계학의의(u=46、47,균P＜0.05).SUVmax4재유무진전조간(5.3±3.9여2.4±1.7)、유무복발조간(5.6±4.0여2.4±1.5)화유무사망조간(5.8±4.2여2.6±1.5)차이균유통계학의의(u=31、26、29,균P＜0.05);△R14[(SUVmax1-SUVmax4)/SUVmax1]적차이야여차(0.49±0.57여0.76±0.22、0.48±0.60여0.73±0.22、0.44±0.64여0.73±0.19;u=39、50、53,균P＜0.05).28례환자치료전MTV균치위19.3 ml,ROC곡선계산적최우예측역치위12.4 ml(P＜0.01),치료전MTV≥12.4 ml자PFS교＜12.4 ml자단,중위치분별위13.1개월급31.4개월(x2=9.0,P＜0.05).△R14예측PFS급OS적최가역치위0.75.Cox회귀다인소생존분석시,MTV시영향PFS급RFS적독립예후인소,Wald치의차위10.80、10.30,풍험비의차위1.13、1.14.결론 CCRT전적MTV시예측비수술식관암CCRT료효적독립예후인소.SUVmax2～4대치료후적RFS가능유일정적예측작용.SUVmax4감소소우75％적환자PFS、RFS、OS균교차.
    Objective To investigate the metabolic changes during the concurrent chemoradiotherapy (CCRT) of non-surgical esophageal squamous cell cancer (ESCC) and to explore the predictive value of sequential 18F-FDG PET/CT scan in CCRT.Methods From May 2009 to October 2011,28 patients with pathologically confirmed ESCC were prospectively enrolled into this study.All patients received definitive treatment with CCRT.18F-FDG PET/CT scans were performed at the following 4 time points:before therapy,at the time when radiation dose reached 50 Gy and 60 Gy,and one month after treatment completion.SUVmax of the 4 time points were recorded as SUVmax1--4.The volume of the area with SUV greater than 40％SUVmax in primary tumor and adjacent lymph node was summed and named as MTV.The starting point of all survival data was from primary disease documentation.All patients had regular follow-up (median time:18.5 months) to record the disease status,including progress free survival (PFS),recurrence free survival (RFS) and overall survival (OS).Patients were divided into different groups according to the following status:progress free or progress,no recurrence or recurrence and death or living.The Mann-Whitney u test was used to compare SUVmax and the rate of △SUVmax in different groups.The AUC of ROC curve was calculated to find the optimal threshold of MTV.Kaplan-Meier and Cox regression were utilized to analyze the differentiation of survival.Results Among the 28 patients,19 showed disease progression,17 showed recurrence and 15 died during follow-up.In the groups of recurrence or no recurrence,there were statistical differences for SUVmax2 and SUVmax3,(SUVmax2:7.4±3.3 vs 4.8±2.5 ; SUVmax3:5.5±2.1 vs 3.8±2.1 ; u =46 and 47,both P＜0.05).As for SUVmax4,statistical differences could be found at every survival group (progress vs progress free:5.3±3.9 vs 2.4± 1.7 ; recurrence vs no recurrence:5.6±4.0 vs 2.4± 1.5 ; death vs living:5.8±4.2 vs 2.6± 1.5; u =31,26 and 29,all P＜0.05).The analysis of the derived parameters of SUVmax showed that △R14 ((SUVmax 1-SUVmax4)/SUVmax 1) had a statistically significant difference between any comparable groups (progress vs progress free:0.49±0.57 vs 0.76±0.22; recurrence vs no recurrence:0.48±0.60 vs 0.73±0.22; death vs living:0.44±0.64 vs 0.73±0.19,u=39,50,53,all P＜0.05).ROC curve was used to obtain the optimal threshold of MTV for predicting the recurrence or not,and it showed that 12.4 ml was the optimal value with the AUC of 0.93.Using this cut-off value,the survival analysis showed a poor prognosis with MTV more than 12.4 ml.The median survival time of MTV less or more than 12.4 ml was 31.4 and 13.1 months respectively (x2 =9.0,P＜0.05).The optimal threshold of △R14 for patients' status of progress free or progress and death or living was 0.75.Multivariate Cox regression survival analysis indicated that the pre-treatment MTV was an independent prognostic factor for PFS and RFS (Wald values:10.80 and 10.30,hazard ratios:1.13 and 1.14 respectively).Conclusions In this group of nonsurgical ESCC patients with CCRT,pre-treatment MTV could independently predict the survival.SUVmaxax2,SUVmax3 and SUVmax4 could be able to predict the RFS.The patients with reduction of SUVmax4 to SUVmax1less than 75％ had a poor PFS,RFS and OS.
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