18F-FDG PET/CT代谢参数对卵巢癌术后患者临床、病理和生物学因素的研究

Correlation of 18F-FDG PET/CT metabolic parameters with clinical,pathological, and biological factors in patients with ovarian cancer after surgery

摘要:

目的：探讨卵巢癌术后行氟代脱氧葡萄糖正电子发射断层扫描（fluorodeoxyglucose positron emission tomography，18F-FDG PET/CT）检查的最大标准摄取值（maximum standard uptake value，SUVmax）、代谢体积（metabolic tumor volume，MTV）及病灶糖酵解总量（total lesion glycolysis，TLG）与患者年龄、国际妇产科联盟（Federation International of Gynecology and Obstetrics，FI－GO）分期、病理分型、糖类抗原125（CA125）、人附睾蛋白-4（HE4）、增殖抗原Ki-67、抑癌基因蛋白p53、肾母细胞瘤基因蛋白WT1的相关性。方法：回顾性分析卵巢癌术后行18F-FDG PET/CT检查的患者80例，测量、计算SUVmax、MTV、TLG等代谢参数。用秩和检验分析代谢参数与年龄、FIGO分期、病理分型、CA125、HE4、Ki-67、p53、WT1的相关性。结果：① SUVmax在Ⅲ-Ⅳ期中明显高于Ⅰ-Ⅱ期（Z=-1.985，P=0.047），SUVmax在WT1阳性表达患者中明显高于WT1表达阴性患者（Z=-2.101，P=0.036）。②MTV在CA125及HE4高表达患者中明显高于低表达患者（Z=-2.323，P=0.020；Z=-2.981，P=0.003）。Ki-67高表达患者与p53、WT1阳性表达患者MTV明显高于Ki-67低表达患者与p53、WT1阴性表达患者（Z=-2.134，P=0.033；Z=-1.970，P=0.049；Z=-2.290，P=0.021）。③ TLG在HE4高表达患者中高于低表达患者，具有统计学差异（Z=-2.712，P=0.007）。Ki-67高表达患者与p53阳性表达患者及WT1阳性表达患者TLG明显高于Ki-67低表达患者与p53、WT1阴性表达患者（Z=-2.198，P=0.028；Z=-2.356，P=0.018；Z=-2.751，P=0.005）。结论：卵巢癌术后18F-FDG PET/CT各个代谢参数与临床、病理及生物学因素都有一定程度相关性，与SUVmax相关的是FIGO分期和WT1，而CA125、HE4、Ki-67、p53、WT1与代表肿瘤负荷程度的MTV、TLG密切相关。MTV、TLG能在一定程度上反映卵巢癌术后复发和转移患者肿瘤部分病理特征，有助于判断肿瘤恶性程度、预测患者预后等。

Abstract:

Objective：To investigate the correlation of maximum standard uptake value（SUVmax），metabolic tumor volume（MTV），and total lesion glycolysis（TLG） on 18F-FDG PET/CT with patient age，Federation International of Gynecology and Obstetrics（FIGO） stage，pathological classification，carbohydrate antigen 125（CA125），human epididymis protein-4（HE4），proliferation antigen Ki-67，tumor suppressor gene protein p53，and Wilms tumor gene product WT1 in patients with ovarian cancer after surgery. Methods：A retrospectively analysis was performed for the clinical data of 80 patients with ovarian cancer who underwent 18F-FDG PET/CT，and the metabolic parameters including SUVmax，MTV，and TLG were calculated. A rank sum test was used to investigate the correlation of the metabolic parameters with age，FIGO stage，pathological classification，CA125，HE4，Ki-67，p53，and WT1. Results：The patients with stage Ⅲ/Ⅳ ovarian cancer had a significantly higher SUVmax than those with stage Ⅰ/Ⅱ ovarian cancer（Z=-1.985，P=0.047），and the patients with positive expression of WT1 had a significantly higher SUVmax than those with negative expression of WT1（Z=-2.101，P=0.036）. The patients with high expression of CA125 and HE4 had a significantly higher MTV than those with low expression（Z=-2.323 and -2.981，P=0.020 and 0.003）. The patients with high expression of Ki-67 had a significantly higher MTV than those with low expression（Z=-2.134，P=0.033），and the patients with positive expression of p53 and WT1 also had a significantly higher MTV than those with negative expression（Z=-1.970 and -2.290，P=0.049 and 0.021）. The patients with high expression of HE4 had a significantly higher TLG than those with low expres－sion（Z=-2.712，P=0.007）. The patients with high expression of Ki-67 had a significantly higher TLG than those with low expression（Z=-2.198，P=0.028），and the patients with positive expression of p53 and WT1 had a significantly higher TLG than those with negative expression（Z=-2.356 and -2.751，P=0.018 and 0.005）. Conclusion：There is a certain degree of correlation between 18F-FDG PET/CT metabolic parameters and clinical/pathological/biological factors in patients with ovarian cancer after surgery. SUVmax is correlated with FIGO stage and WT1，and CA125，HE4，Ki-67，p53，and WT1 are closely correlated with MTV and TLG representing the degree of tumor burden. To a certain degree，MTV and TLG can reflect some features of patients with recurrence and metastasis after surgery for ovarian cancer and help to determine the degree of tumor malignancy and predict patient prognosis.