早期宫颈癌盆腔淋巴结转移危险因素及PET/CT诊断

摘要

Objective To explore risk factors of pelvic lymph node (PLN) metastasis in cervical cancer,and to observe the value of PET/CT in diagnosis of PLN metastasis with qualitative and semi-quantitative evaluation.Methods Clinical data of 206 patients with cervical cancer who underwent PLN dissection were respectively analyzed.The age and BMI of patients,pathological type,depth of invasion and International Federation of Gynecology and Obstetrics (FIGO) stage of tumor,serum SCC level,lymph node status of PET/CT and tumor SUVmax were analyzed with univariate analysis.Multivariate analysis was performed for indicators with statistically significant variables.The accuracy,sensitivity and specificity of PET/CT in diagnosis of PLN metastasis of cervical cancer were calculated.Besides,the ratios of lymph node 'S SUVmax (SUVmaxLN) to SUVmax of primary tumor (SUVmaxL/T),to liver (SUVmaxL/H) and to arota (SUVmaxL/A) were recorded.ROC curves were plotted,whereas the areas under curve (AUC) were calculated to confirm the best diagnostic cutoff value.Results Univariate analysis showed that age,BMI,pathological type,depth of invasion,FIGO stage,serum SCC level,lymph node status of PET/CT and tumor SUVmax were important factors of PLN metastasis (all P＜0.05).Multivariate analysis revealed that serum SCC levels,depth of invasion,lymph node status of PET/CT and tumor SUVmax were independent predictors of PLN metastasis (P＜0.05).The sensitivity,specificity and accuracy of PET/CT in diagnosis of PLN metastasis was 54.90％ (28/51),91.61％ (142/155) and 82.52％ (170/206),respectively.The sensitivity of SUVmaxLN =4.19 was higher than SUVmax =2.5.No significant difference of SUVmaxLN with SUVmaxL/T,with SUVmaxL/H nor with SUVmaxL/A was found.Conclusion Serum SCC levels,depth of invasion,lymph node status of PET/ CT and tumor SUVmax are independent predictors of PLN metastasis.PET/CT has certain value in qualitative and semiquantitative analysis of cervical cancer PLN metastasis.%目的 分析宫颈癌盆腔淋巴结转移危险因素,并探讨PET/CT定性及半定量诊断盆腔淋巴结转移的价值.方法 回顾性分析接受盆腔淋巴结清扫术的206例宫颈癌患者的临床资料,对年龄、BMI指数、病理类型、浸润深度、国际妇产科联盟(FIGO)分期、血清SCC水平、PET/CT淋巴结转移情况及原发灶SUVmax行单因素分析,并对上述有统计学意义的指标行多因素分析;计算PET/CT诊断宫颈癌盆腔淋巴结转移的准确率、敏感度及特异度;记录淋巴结SUVmax值(SUVmaxLN)及其与原发灶、肝脏、腹主动脉SUVmax的比值(SUVmaxL/T、SUVmaxL/H、SUVmaxL/A).绘制ROC曲线,计算曲线下面积(AUC),确定最佳诊断界值.结果 单因素分析显示,年龄、BMI指数、病理类型、浸润深度、FIGO分期、血清SCC水平、PET/CT提示淋巴结转移以及原发灶SUVmax为宫颈癌淋巴结转移的重要因素(P＜0.05).多因素分析显示血清SCC水平、肿瘤浸润深度、PET/CT提示盆腔淋巴结转移及原发灶SUVmax值是宫颈癌淋巴结转移的独立危险因素(P＜0.05).PET/CT诊断宫颈癌盆腔淋巴结转移的敏感度为54.90％ (28/51),特异度为91.61％ (142/155),准确率为82.52％(170/206).SUVmaxLN=4.19的诊断准确率高于传统界值(SUVmax=2.5).与SUVmaxLN相比,以SUVmaxL/T、SUVmaxL/H、SUVmaxL/A诊断宫颈癌盆腔淋巴结转移的ROC曲线差异无统计学意义.结论 血清SCC水平、肿瘤浸润深度、PET/CT提示盆腔淋巴结转移及原发灶SUVmax值是早期宫颈癌盆腔淋巴结转移的独立危险因素.PET/CT在定性及半定量评价宫颈癌盆腔淋巴结转移方面均具有一定价值.