目的:应用18F-FDG代谢PERCIST1.0及解剖学RECIST1.1两种标准评价官颈癌同步放化疗(CCRT)治疗反应,对比分析两种标准评价结果的差异及治疗反应与血清鳞状细胞癌抗原(SCC-Ag)的相关性.方法:回顾性分析2011年10月-2016年2月间多中心病理证实原发官颈鳞癌患者共22例,FIGO分期ⅡB～Ⅳ期,分别于治疗前后行两次18F-FDG PET/CT扫描,应用PETCIST1.0及RECIST1.1标准评价治疗效果.同时观察不同治疗反应组患者治疗前、后的血清SCC-Ag变化水平.结果:PERCIST1.0标准评价结果:CMR 3例、PMR 9例、SMD 7例及PMD 3例;RECIST1.1标准评价结果:CR 0例、PR 11例、SD7例及PD 4例.两种标准评价结果之间存在明显差异(x2=16.76,P=0.01),Kappa值为0.321(P=0.018),其中10/22(45.45％)例患者两种标准评价结果不一致.PERCIST1.0和RECIST1.1标准评价治疗有效率(CMR/CR+PMR/PR)分别为:54.55％(12/22)和50％(11/22),其中PERCIST1.0评价为2例CMR、6例PMR及3例SMD,而RECIST1.1全部评价为PR;同时,RECIST 1.1评价7例SD,而PERCIST1.0评价为1例CMR、3例PMR及3例SMD.治疗后不同治疗反应组患者SCC-Ag水平存在明显差异(F=7.08,P=0.002),且两者之间存在明显正相关(γ=0.529,P=0.011).有效组(CMR+PMR)治疗前、后SCC-Ag存在明显差异(T=2.28,P=0.044);而无效组(SMD+PMD)治疗前、后SCC-Ag明显不显著(T=-0.42,P=0.687).结论:PERCIST1.0和RECIST1.1两种标准对宫颈癌CCRT治疗反应的评价结果存在明显差异.PERCIST1.0标准更能准确评价官颈癌CCRT的不同治疗反应.%Objective:To compare 18F-FDG metabolism with morphologic criteria for evaluating concurrent chemoradiotherapy (CCRT) response of cervical cancer,and to analyze to relationship between treatment response and serum squamous cell carcinoma antigen(SCC-Ag) levels.Methods:From October 2011 to February 2016,twenty-two patients with primary advanced cervical cancer confirmed by pathology were enrolled in this retrospective study,with FIGO stage Ⅱ B～Ⅳ.18F-FDG PET/CT was performed before and after CCRT and therapeutic response evaluation was performed according to both PERCIST1.0 and RECIST1.1.Pre-and post-treatment SCC-Ag levels were observed.Results:In PERCIST1.0 analysis,3 cases had CMR,9 cases had PMR,7 cases had SMD,and 3 cases had PMD.In RECIST1.1 analysis,11 cases had PR,7 cases had SD,4 cases had PD and no patient had CR.There was significant difference in response classification between the two criteria (x2=16.76,P=0.01).There was 45.45％(10/22) disagreement found with a fair agreement (P=0.018).The therapeutic response rates (CMR/CR+PMR/PR) were 54.55％(12/22) and 50％(11/22),respectively.Of the 11 patients with PR by RECIST1.1 were classified to 2 CMR,6 PMR and 3 SMD by PERCIST1.0.At same time,of the 7 cases with SD by RECIST1.1 were classified to 1 CMR,3 PMR and 3 SMD by PERCIST1.0.The post-treatment SCC-Ag levels of different therapeutic response groups were significantly different(F=7.08,P=0.002),and there was positive correlated between them(γ=0.529,P=0.011).There was a significant difference between pre-and post-treatment SCC-Ag levels for therapeutic response group (T=2.28,P=0.044),while there was no significantly different for therapy no-response group(T=-0.42,P=0.687).Conclusion:Disagreement was found in CCRT therapeutic response of cervical cancer evaluation and PERCIST1.0 may be more accurately distinguish to therapeutic response.
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