收稿日期: 2023-09-21
网络出版日期: 2024-04-08
基金资助
中央高校基本科研基金项目(WK9110000192)
The predictive value of 18F⁃FDG PET/CT metabolic heterogeneity parameters combined with clinical features for the prognosis of esophageal squamous cell carcinoma before definitive radiochemotherapy
Received date: 2023-09-21
Online published: 2024-04-08
目的 探讨根治性放化疗（D-CRT）前18F-FDG PET/CT代谢和异质性参数结合临床特征对食管鳞状细胞癌（ESCC）患者预后的预测价值。 方法 回顾性分析接受D-CRT的106例ESCC患者的临床资料，所有患者在治疗前均接受了18F-FDG PET/CT检查，通过数据处理获得肿瘤原发灶的代谢和异质性参数。随访所有患者的总生存期。采用Kaplan-Meier法和Cox比例风险模型分析患者临床特征、肿瘤代谢和异质性参数与患者预后的关系。 结果 所有患者1、1.5年总生存率分别为77.4%、51.9%，中位生存时间为20个月。单因素分析表明：N分期、M分期、肿瘤代谢体积、病灶糖酵解总量、异质性指数-2（HI-2）、40%最大标准化摄取值为阈值的变异系数（CV40%）与ESCC预后相关（P < 0.05）。多因素分析表明：N分期、CV40%是ESCC患者预后的独立危险因素（P = 0.039、 < 0.001）。 结论 N分期、肿瘤代谢异质性参数CV40%与ESCC D-CRT患者的预后密切相关，并具有一定的预测价值。
马希雅 , 季虎 , 朱泽华 , 潘博 , 谢强 , 姚晓波 . 根治性放化疗前18F-FDG PET/CT代谢异质性参数结合临床特征对食管鳞状细胞癌预后的预测价值[J]. 实用医学杂志, 2024 , 40(7) : 966 -971 . DOI: 10.3969/j.issn.1006-5725.2024.07.015
Objective This study aimed to explore the prognostic value of 18F?FDG PET/CT Metabolic and Heterogeneity Parameters Combined with Clinical Features Before Definitive Chemoradiotherapy （D?CRT） in predicting the prognosis of esophageal squamous cell carcinoma （ESCC） Patients. Methods A retrospective analysis was conducted on clinical data from 106 patients with ESCC who received D?CRT at the first affiliated Hospital of University of Science and Technology of China between January 2017 and December 2021. All patients underwent 18F?FDG PET/CT examination before the treatment. The primary tumor's metabolic and heterogeneity parameters were obtained through data processing. All patients were followed up for overall survival. The Kaplan?Meier method and Cox proportional hazards models were used to analyze the association between clinical features， tumor metabolism and heterogeneity parameters and patient prognosis. Results The 1? and 1.5?year overall survival rates of all patients were 77.4%and 51.9%. The median survival time was 20 months. Univariate analysis showed that N stage， M stage， metabolic tumor volume， total lesion glycolysis， heterogeneity index?2 （HI?2）， and coefficient of variation with a threshold of 40% maximum standard uptake value （CV40%） were correlated with the prognosis of ESCC （all P< 0.05）. Multivariate analysis showed that N stage and CV40% were independent predictors of prognosis in patients with ESCC （P = 0.039 and P < 0.001， respectively）. Conclusion N stage and tumor metabolic heterogeneity parameter CV40%， which offering a degree of predictive value， are closely related to the prognosis of patients with ESCC treated with D?CRT.
| 1 | SHEN D H Y， CHAN H P， TSAI F R， et al. Prognostic Value of 18F-FDG PET/CT Volume-Based Metabolic Parameters in Patients with Node-Negative Stage II Esophageal Squamous Cell Carcinoma［J］. Metabolites， 2021， 12（1）： 7. doi:10.3390/metabo12010007 |
| 2 | ALOTAIBI A， GADEKAR V P， GUNDLA P S， et al. Global comparative transcriptomes uncover novel and population-specific gene expression in esophageal squamous cell carcinoma［J］. Infect Agent Cancer， 2023，18（1）：47. doi:10.1186/s13027-023-00525-8 |
| 3 | 中国医师协会放射肿瘤治疗医师分会， 中华医学会放射肿瘤治疗学分会， 中国抗癌协会肿瘤放射治疗专业委员会. 中国食管癌放射治疗指南（2021年版）［J］. 国际肿瘤学杂志， 2022， 49（1）：14. doi:10.3760/cma.j.cn371439-20211021-00002 |
| 4 | 邱云亮， 郭喆， 孙晋， 等. 18F-FDG PET/CT代谢参数预测老年食管鳞癌预后的价值［J］. 中国医学影像学杂志， 2021， 29（10）： 998-1002. doi:10.3969/j.issn.1005-5185.2021.10.009 |
| 5 | LIU X， ZHANG Y F， SHI Q， et al. Prediction value of 18F-FDG PET/CT intratumor metabolic heterogeneity parameters for recurrence after radical surgery of stage Ⅱ/Ⅲ colorectal cancer［J］. Front Oncol， 2022， 12： 945939. doi:10.3389/fonc.2022.945939 |
| 6 | LIU G， YIN H， CHENG X， et al. Intra-tumor metabolic heterogeneity of gastric cancer on 18 F-FDG PETCT indicates patient survival outcomes［J］. Clin Exp Med， 2021，21（1）：129-138. doi:10.1007/s10238-020-00659-8 |
| 7 | JO J H， CHUNG H W， SO Y， et al. FDG PET/CT to predict recurrence of early breast invasive ductal carcinoma［J］. Diagnostics， 2022， 12（3）： 694. doi:10.3390/diagnostics12030694 |
| 8 | NI M， WANG S， LIU X， et al. Predictive value of intratumor metabolic and heterogeneity parameters on ［18F］ FDG PET/CT for EGFR mutations in patients with lung adenocarcinoma［J］. Jpn J Radiol， 2023，41（2）：209-218. doi:10.1007/s11604-022-01347-1 |
| 9 | 中国非手术治疗食管癌临床分期专家小组. 非手术治疗食管癌的临床分期标准（草案） ［J］. 中华放射肿瘤学杂志， 2010， 19（3）： 179-180. doi:10.3760/cma.j.issn.1004-4221.2010.03.001 |
| 10 | METZGER J C， WOLLSCHL?GER D， MIEDERER M， et al. Inclusion of PET-CT into planning of primary or neoadjuvant chemoradiotherapy of esophageal cancer improves prognosis［J］.Strahlenther Onkol， 2017， 193（10）： 791. doi:10.1007/s00066-017-1164-3 |
| 11 | 于珺，李永顺，黄长荣，等. FDG PET/CT代谢体积对食管癌术后预后的预测价值［J］. 影像研究与医学应用， 2018，2（21）：193-194. doi:10.3969/j.issn.2096-3807.2018.21.130 |
| 12 | 戴亮，付浩，王菲，等. 食管鳞癌原发肿瘤正电子发射计算机断层显像的最大标准摄取值与术后生存相关分析［J］. 中华医学杂志， 2018，98（21）：1707-1712. doi:10.3760/cma.j.issn.0376-2491.2018.21.017 |
| 13 | MARTíNEZ A， INFANTE J R， QUIRóS J， et al. Baseline 18F-FDG PET/CT quantitative parameters as prognostic factors in esophageal squamous cell cancer［J］. Rev Esp Med Nucl Imagen Mol （Engl Ed）， 2022，41（3）：164-170. doi:10.1016/j.remnie.2021.07.006 |
| 14 | LI Y， HOFHEINZ F， FURTH C， et al. Increased evidence for the prognostic value of FDG uptake on late-treatment PET in non-tumour-affected oesophagus in irradiated patients with oesophageal carcinoma［J］. Eur J Nucl Med Mol Imaging， 2018， 45（10）： 1752-1761. doi:10.1007/s00259-018-3996-1 |
| 15 | YUAN Y. Spatial heterogeneity in the tumor microenvironment［J］. Cold Spring Harb Perspect Med， 2016，6（8）：a026583. doi:10.1101/cshperspect.a026583 |
| 16 | ZHU L， JIANG M， WANG H， et al. A narrative review of tumor heterogeneity and challenges to tumor drug therapy［J］. Ann Transl Med， 2021，9（16）：1351. doi:10.21037/atm-21-1948 |
| 17 | KIM Y， KIM Y J， PAENG J C， et al. Heterogeneity index evaluated by slope of linear regression on 18F-FDG PET/CT as a prognostic marker for predicting tumor recurrence in pancreatic ductal adenocarcinoma［J］. Eur J Nucl Med Mol Imaging， 2017，44（12）：1995-2003. doi:10.1007/s00259-017-3755-8 |
| 18 | KIM T H， YOON J K， KANG D K， et al. Correlation between F-18 fluorodeoxyglucose positron emission tomography metabolic parameters and dynamic contrast-enhanced MRI-derived perfusion data in patients with invasive ductal breast carcinoma［J］.Ann Surg Oncol， 2015，22（12）：3866-3872. doi:10.1245/s10434-015-4526-z |
| 19 | CHUNG H H， KANG S Y， HA S， et al. Prognostic value of preoperative intratumoral FDG uptake heterogeneity in early stage uterine cervical cancer［J］. J Gynecol Oncol， 2016， 27（2）： e15. doi:10.3802/jgo.2016.27.e15 |
| 20 | DONG X， XING L， WU P， et al. Three-dimensional positron emission tomography image texture analysis of esophageal squamous cell carcinoma： relationship between tumor： 18： F-fluorodeoxyglucose uptake heterogeneity， maximum standardized uptake value， and tumor stage［J］. Nucl Med Commun， 2013，34（1）：40-46. doi:10.1097/mnm.0b013e32835ae50c |
| 21 | GOPAL A， XI Y， SUBRAMANIAM R M， et al. Intratumoral Metabolic Heterogeneity and Other Quantitative 18F-FDG PET/CT Parameters for Prognosis Prediction in Esophageal Cancer［J］.Radiol Imaging Cancer， 2020， 3（1）： e200022. doi:10.1148/rycan.2020200022 |
/
| 〈 |
|
〉 |