18F-FDG PET/CT中病灶糖酵解总量判断局部晚期胰腺癌放射治疗的预后价值

摘要

目的：利用18F-氟脱氧葡萄糖正电子发射断层扫描计算机层析成像技术(18F-FDG PET/CT)中病灶糖酵解总量(TLG)参数，分析局部晚期胰腺癌放射治疗前18F-FDG PET/CT显像中肿瘤TLG与预后的关系。方法：回顾性分析33例治疗前行18F-FDG PET/CT显像的局部晚期胰腺癌患者，将33例患者以TLG的中位值(55.3)为切分点进行分组，TLG＜55.3为A组(16例)， TLG≥55.3为B组(17例)。所有患者均以标准化摄取值(SUV)2.5为阈值，获得全身肿瘤的TLG。采用Kaplan-Meier生存分析法和Log-rank检验分析比较预后危险因素和TLG的预后价值。结果：A组和B组患者的中位生存时间分别为15.5和8个月，两组患者的生存时间差异有显著相关性(r=7.765，P=0.005)；两组患者GTV剂量、治疗前CA19-9均有差异(x2=7.162，x2=10.476， P=0.05)，且为影响局部晚期胰腺癌患者放射治疗预后危险因素；多因素分析显示TLG的参数为P=0.009，为患者生存预后的独立影响因素。结论：治疗前CA19-9和GTV剂量均为影响局部晚期胰腺癌患者放射治疗预后危险因素；TLG是患者生存预后的独立影响因素。放射治疗前肿瘤原发灶的TLG参数在预测局部晚期胰腺癌患者预后方面具有一定的临床价值，能够指导临床及早制定个体化诊疗计划，有望延长患者总生存。%Objective:Total lesion glycolysis (TLG) on PET scans were calculated using custom-designed software, then we analyzed the prognostic utility of PET for patients with locally advanced pancreatic cancer (LAPC) undergoing radiation therapy.Methods: 33 patients with newly diagnosed LAPC who underwent 18F- FDG PET/CT scan for staging before radiation therapy were retrospectively included in this study. Patients were divided into two different groups by the median value of TLG. TLG lower than 55.3 was A group and TLG higher or equal to 55.3 was B group. TLG of tumor tissue were calculated from PET/CT images with the SUV cut-off value of 2.5. We analyzed the relationship between TLG and other clinical factors and prognosis in patients with pancreatic cancer by Kaplan-Meier method and log-rank test.Results: By Log-rank univariate analysis showed that the differences in group A and group B related significantly (r=7.765,P=0.005). And their middle survival time was 15.5 months and 8 months respectively. GTV dose of the patients in two groups and CA19-9 before treatment were also statistically different (x2=7.162, x2=10.476;P=0.05). Multivariate analysis showed that the TLG (P=0.009) were independent risk factors that prevented the long-term survival of the prognosis of patients in this group.Conclusion: The value of CA19-9 and GTV dose before treatment were the risk factors of radiotherapy for patients with locally advanced pancreatic cancer. The parameters of TLG were independent prognostic factors. TLG have a certain clinical value in predicting the prognosis of patients with pancreatic cancer, and can guide clinical diagnosis and treatment planning, and extend the lifespan of patients with pancreatic cancer.