18F-脱氧葡萄糖PET/CT代谢参数在预测交界可切除及局部晚期胰腺癌患者接受新辅助化疗后病理反应及预后价值分析
18 F-fluordeoxyglucose PET/CT metabolic parameters in predicting the pathological response and prognosis of patients with borderline resectable and locally advanced pancreatic cancer after receiving neoadjuvant chemotherapy
杜磊 1王观筠 1徐晓丹 1张靖峰 1韩蕴 1王瑞民 1徐白萱1
作者信息
- 1. 解放军总医院 第一医学中心 核医学科,北京 100853
- 折叠
摘要
目的 探讨18F-脱氧葡萄糖(18F-FDG)PET/CT代谢参数在预测交界可切除及局部晚期胰腺癌患者接受新辅助化疗(NACT)后的病理反应及预后的价值.方法 回顾性分析自 2021 年 11 月至 2023 年 12 月在解放军总医院接受18F-FDG PET/CT检查和NACT的39 例胰腺癌患者的临床资料.根据接受NACT后的病理反应将患者分为治疗反应组(n =12)与治疗无反应组(n = 27).比较两组患者的18F-FDG PET/CT 代谢参数,包括最大标准摄取值(SUVmax)、平均标准摄取值(SUVmean),并以病变SUVmax的40%作为阈值计算肿瘤代谢体积(MTV)和总葡萄糖酵解(TLG);比较两组治疗前、后的18F-FDG PET/CT代谢参数差值(ΔSUVmax、ΔSUVmean、ΔTLG、ΔMTV),以及代谢参数差值百分比(ΔSUVmax%、ΔSUVmean%、ΔTLG%、ΔMTV%).收集患者的预后情况并进行 Kaplan-Meier分析.结果 两组18F-FDG PET/CT代谢参数中的治疗后SUVmax、SUVmean及ΔSUVmax%比较,差异均有统计学意义(P<0.05).治疗后SUVmax和ΔSUVmax%显示出较好的曲线下面积(AUC),其中,治疗后SUVmax的AUC为0.790(95%可信区间:0.641～0.939),最佳诊断阈值为3.09,敏感性和特异性分别为0.917(0.598～0.996)、0.667(0.460～0.828);ΔSUVmax%的AUC为0.753(95%可信区间:0.593～0.913),最佳诊断阈值为51.5%,敏感性和特异性分别为 0.917(0.598～0.996)、0.703(0.497～0.855).当治疗后TLG =17.94 作为阈值时,与治疗后TLG>17.94 的患者比较,治疗后TLG<17.94 的患者具有更好的总生存期(log-rank χ2 =7.793,P =0.005),但无进展生存期比较,差异无统计学意义(χ2 =3.450,P =0.063).结论 18F-FDG PET/CT代谢参数对预测接受NACT的交界可切除及局部晚期胰腺癌患者病理反应和预后中具有较高的临床价值,在一定程度上能够为接受NACT的交界可切除及局部晚期胰腺癌患者的治疗提供更多核医学层面的帮助.
Abstract
Objective To explore the value of 18F-fluorodeoxyglucose(18F-FDG)PET/CT metabolic parameters in predicting the path-ological response and prognosis of patients with borderline resectable and locally advanced pancreatic cancer after receiving neoadju-vant chemotherapy(NACT).Methods Clinical data of 39 patients with pancreatic cancer who underwent 18F-FDG PET/CT examina-tion and NACT at Chinese PLA General Hospital from November 2021 to December 2023 were retrospectively analyzed.The patients were divided into treatment response group(n =12)and treatment non-response group(n =27)according to their pathological reactions after receiving NACT.The 18F-FDG PET/CT metabolic parameters of the two groups were compared,including the maximum standard uptake value(SUVmax)and the average standard uptake value(SUVmean),and the metabolic tumor volume(MTV)and total glucose glycolysis(TLG)were calculated using 40%of the pathological SUVmax as the threshold value.The difference of 18F-FDG PET/CT metabolic parameters before and after treatment(ΔSUVmax,ΔSUVmean,ΔTLG,ΔMTV)and the percentage difference of metabolic pa-rameters(ΔSUVmax%,ΔSUVmean%,ΔTLG%,ΔMTV%)were compared between the two groups before and after treatment.The prognosis of the patients was collected and Kaplan-Meier analysis was performed.Results There were significant differences in SUVmax,SUVmean and ΔSUVmax%of 18F-FDG PET/CT metabolic parameters between the two groups after treatment(P<0.05).SUVmax and ΔSUVmax%showed good area under the curve(AUC)after treatment,where the AUC of SUVmax after treatment was 0.790(95%confidence interval:0.641-0.939),the optimal diagnostic threshold was 3.09,the sensitivity and specificity were 0.917(0.598-0.996)and 0.667(0.460-0.828),respectively.The AUC of ΔSUVmax%was 0.753(95%confidence interval:0.593-0.913),the optimal diagnostic threshold was 51.5%,and the sensitivity and specificity were 0.917(0.598-0.996)and 0.703(0.497-0.855),respectively.When TLG =17.94 after treatment was taken as the threshold,patients with TLG<17.94 after treatment had better overall survival(log-rank χ2 =7.793,P =0.005)compared with patients with TLG>17.94 after treatment,but the difference in progression-free survival was not statistically significant(χ2 =3.450,P =0.063).Conclusion 18F-FDG PET/CT metabolic parame-ters have high clinical value in predicting the pathological response and prognosis of borderline resectable and lacally alvanced pancre-atic cancer patients receiving NACT,and can provide more nuclear medicine help for the treatment of borderline resectable and locally advanced pancreatic cancer patients receiving NACT to a certain extent.
关键词
18F-脱氧葡萄糖PET/CT/代谢参数/交界可切除及局部晚期胰腺癌/病理反应/预后Key words
18F-fluorodeoxyglucose PET/CT/Metabolic parameters/Borderline resectable and locally advanced pancreatic cancer/Pathological reaction/Prognosis引用本文复制引用
基金项目
国家自然科学基金面上项目(82071958)
出版年
2024
NETL
NSTL
万方数据