摘要
目的探讨^(18)F-氟脱氧葡萄糖(FDG)PET/CT代谢参数对中晚期宫颈鳞癌转移性淋巴结同步放化疗(CCRT)疗效的预测价值。方法回顾性分析2016年12月至2020年12月于川北医学院附属医院行CCRT的50例中晚期宫颈鳞癌患者(ⅢC期22例、ⅣA期4例、ⅣB期24例)的临床资料,年龄(50.7±8.6)岁。根据CCRT前后转移性淋巴结的变化情况,将患者分为有效组(36例)和无效组(14例),分析^(18)F-FDG PET/CT代谢参数最大标准化摄取值(SUV_(max))、肿瘤代谢体积(MTV)、糖酵解总量(TLG)以及其他相关临床特征(如患者年龄、临床分期)对中晚期宫颈鳞癌转移性淋巴结CCRT疗效的预测价值。符合正态分布的计量资料以±s表示,组间比较采用两独立样本t检验(方差齐);不符合正态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Mann-WhitneyU检验;分类变量以例(%)表示,组间比较采用χ^(2)检验或Fisher确切概率法。根据受试者工作特征(ROC)曲线获得^(18)F-FDG PET/CT代谢参数预测转移性淋巴结CCRT疗效的最佳临界值,并根据最佳临界值进行分类,对分类后的变量进行单因素Logistic回归分析,并采用多因素Logistic回归分析确定中晚期宫颈鳞癌转移性淋巴结CCRT疗效潜在的独立预测因子和预测效能。结果 2组间患者的年龄、临床分期和SUVmax差异均无统计学意义(t=0.464、Fisher确切概率法、Z=0.864,均P>0.05);2组间MTV和TLG的差异有统计学意义(Z=3.457、3.630,均P<0.05)。单因素Logistic回归分析结果显示,MTV和TLG均与中晚期宫颈鳞癌转移性淋巴结CCRT疗效存在相关性(OR=7.333、15.600,均P<0.05)。多因素Logistic回归分析结果显示,TLG<26.265 g(OR=8.335,95%CI:1.040~66.817,χ^(2)=3.987,P=0.046)是中晚期宫颈鳞癌转移性淋巴结CCRT疗效潜在的独立预测因子。ROC曲线评估TLG对中晚期宫颈鳞癌转移性淋巴结CCRT疗效的结果显示,曲线下面积为0.833(95%CI:0.718~0.949,P< 0.001)。结论 MTV和TLG与中晚期宫颈鳞癌转移性淋巴结CCRT疗效存在相关性,其中TLG<26.265 g对其预测价值较高。
Objective To explore the value of ^(18)F-fluorodeoxyglucose(FDG)PET/CT metabolic parameters in predicting the efficacy of concurrent chemoradiotherapy(CCRT)in metastatic lymph nodes of intermediate-advanced cervical squamous cell carcinoma.Methods The clinical data of 50 patients with intermediate-advanced cervical squamous cell carcinoma(stageⅢC,22 cases;stageⅣA,4 cases;and stageⅣB,24 cases)who underwent CCRT in the Affiliated Hospital of North Sichuan Medical College from December 2016 to December 2020 were analyzed retrospectively.The patients aged(50.7±8.6)years.In accordance with the changes in metastatic lymph nodes before and after CCRT,the patients were divided into effective group(36 cases)and ineffective group(14 cases).The ^(18)F-FDG PET/CT metabolic parameters maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),total lesion glycolysis(TLG)and other related clinical features,such as age and clinical stage,were analyzed to predict the efficacy of CCRT in metastatic lymph nodes of intermediate-advanced cervical squamous cell carcinoma.In accordance with normal distribution,the measurement data were expressed by±s,and comparison between groups was conducted by two independent sample t-test(uniform variance).The measurement data that did not conform to the normal distribution were represented by M(Q_(1),Q_(3)),and Mann-Whitney U test was used for comparison between groups.The classification variables were expressed as an cases(%),andχ^(2) test or Fisher's exact test was used for comparison between groups.In accordance with the receiver operating characteristic(ROC)curves,the best critical value of ^(18)F-FDG PET/CT metabolic parameters for predicting the efficacy of CCRT in metastatic lymph nodes was obtained,and the classified variables were classified on the basis of the optimal critical value.Univariate Logistic regression analysis was used to determine the potential independent predictors and predictive efficacy of CCRT in metastatic lymph nodes of intermediate-advanced cervical squamous cell carcinoma.Results No significant difference was found in the age,clinical stage,and SUVmax between the two groups(t=0.464,Fisher's exact test,Z=0.864;all P>0.05).Significant differences were found in the MTV and TLG between the two groups(Z=3.457,3.630;both P<0.05).The univariate Logistic regression analysis showed that MTV and TLG were correlated with the efficacy of CCRT in metastatic lymph nodes of intermediate-advanced cervical squamous cell carcinoma(OR=7.333,15.600;both P<0.05).The multivariate Logistic regression analysis showed that TLG<26.265 g(OR=8.335,95%CI:1.040–66.817,χ^(2)=3.987;P=0.046)was a potential independent predictor of CCRT efficacy in metastatic lymph nodes of intermediate-advanced cervical squamous cell carcinoma.The ROC curves to evaluate the efficacy of TLG in the CCRT treatment of metastatic lymph nodes showed that the area under curve was 0.833(95%CI:0.718-0.949,P<0.001).Conclusions Correlation exists among MTV,TLG,and the efficacy of CCRT in the metastatic lymph nodes of intermediate–advanced cervical squamous cell carcinoma,and TLG<26.265 g was found to be the highest predictive value.
作者
曾薪宇
黄禹豪
李素平
Zeng Xinyu;Huang Yuhao;Li Suping(Department of Nuclear Medicine,the Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)
出处
《国际放射医学核医学杂志》
2023年第1期11-17,共7页
International Journal of Radiation Medicine and Nuclear Medicine
