摘要： 目的·探讨术前利尿延迟
18氟-氟代脱氧葡萄糖正电子发射计算机断层显像（
18F-fluorodeoxyglucose positron emission tomography/computed tomography，
18F-FDG PET/CT）对于接受膀胱癌根治术患者的预后价值。方法·回顾性分析2016—2018年于上海交通大学医学院附属仁济医院行膀胱癌根治性切除术（radical cystectomy，RC）的104例患者，收集临床资料与利尿延迟
18F-FDG PET/CT图像资料，使用受试者工作曲线获取最大标准化摄取值（maximal standardized uptake value，SUVmax）、肿瘤代谢体积（metabolic tumor volume，MTV）、糖酵解总量（total lesion glycolysis，TLG）等代谢参数的诊断能力与最佳界值，并将受试者分为高SUVmax组（
n=53）和低SUVmax组（
n=51）、高MTV组（
n=52）和低MTV组（
n=52）、高TLG组（
n=67）和低TLG组（
n=37）。将PET/CT代谢参数与临床参数行Pearson
χ2检验，采用Kaplan-Meier法绘制生存曲线与Log-rank法比较组间差异，采用Cox风险回归模型评价PET/CT代谢参数的预后价值。结果·MTV（
P=0.000）和TLG（
P=0.000）对膀胱癌患者的术后复发具有诊断价值。术前治疗情况（
P=0.033）、肿瘤T分期（
P=0.035）与MTV相关，中性粒细胞/淋巴细胞比值（
P=0.026）、血红蛋白（
P=0.004）、白蛋白（
P=0.021）、术前治疗（
P=0.015）、T分期（
P=0.015）与TLG相关。多因素Cox模型提示淋巴结转移（HR=2.433，
P=0.016）、TLG（HR=4.499，
P=0.000）为无进展生存期（progression-free survival，PFS）的独立预后因素，术前治疗（HR=0.220，
P=0.014）、TLG（HR=7.107，
P=0.013）为总生存期（overall survival，OS）的独立预后因素。结论·术前利尿延迟
18F-FDG PET/CT显像可预测膀胱癌患者根治术后的生存情况。
关键词: 膀胱癌, 正电子发射计算机断层显像, 延迟显像, 代谢参数, 预后 Abstract: Objective·To evaluate the prognostic value of preoperative delayed diuretic 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging in patients with bladder cancer.
Methods·The clinical data and preoperative delayed diuretic 18F-FDG PET/CT images of 104 bladder cancer patients who received radical cystectomy (RC) from 2016 to 2018 at Renji Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The diagnostic ability and optimal boundary values of maximum standardized uptake value (SUVmax), tumor metabolic volume (MTV) and total lesion glycolysis (TLG) were obtained by receiver operating characteristic curve (ROC) analysis. Patients were divided into high SUVmax group (n=53) and low SUVmax group (n=51), high MTV group (n=52)and low MTV group (n=52), high TLG group (n=67)and low TLG group (n=37). The correlation between PET/CT metabolic parameters and clinical data was analyzed by chi-square test. Survival curves were drawn by Kaplan-Meier method and tested by Log-rank method. The prognostic value of metabolic parameters was evaluated by Cox regression model.
Results·MTV (P=0.000) and TLG (P=0.000) had diagnostic abilities for postoperative recurrence of bladder cancer. Preoperative treatment (P=0.033) and T stage of tumor (P=0.035) were correlated with MTV, while neutrophil-lymphocyte ratio (NLR) (P=0.026), hemoglobin (P=0.004), albumin(P=0.021), preoperative treatment (P=0.015) and T stage (P=0.015) were related to TLG. Multivariate Cox regression analysis showed that lymph node metastasis (HR=2.433, P=0.016) and TLG (HR=4.499, P=0.000) were independent prognostic factors of progression-free survival (PFS), while preoperative treatment (HR=0.220, P=0.014) and TLG (HR=7.107,P=0.013) were independent predictors of overall survival (OS).
Conclusion·Delayed diuretic 18F-FDG PET/CT before RC can predict the postoperative survival.
Key words: bladder cancer, PET/CT, delayed imaging, metabolic parameters, prognostic prediction PDF全文下载地址:
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