【摘要】 目的 ¹⁸F-氟脱氧葡萄糖(¹⁸F-fluorodeoxyglucose,¹⁸F-FDG)正电子发射计算机断层显像（positron emission tomograpay,PET）图像异质性分析是目前肿瘤异质性分析的重要方法,由于肿瘤异质性与患者放化疗疗效及生存密切相关,故本研究旨在探讨¹⁸F-FDG PET图像视觉异质性评分能否预测Ⅲ期食管鳞癌放化疗疗效及预后。方法回顾性收集在山东大学附属山东省肿瘤医院治疗前行¹⁸F-FDG PET/CT显像的Ⅲ期食管鳞癌患者66例。由2位核医学医师依据视觉异质性分级（1=均质,2=中度异质性,3=重度异质性）独立评价肿瘤原发灶异质性。在¹⁸F-FDG PET/CT图像中提取肿瘤原发灶代谢参数,包括标准化摄取值（standardized uptake value,SUV）相关参数、肿瘤代谢体积（metabolically active tumor volume,MTV）、糖酵解总量（total lesion glycolysis,TLG）。采用Kappa分析比较观察者之间差异;采用Pearsonχ2检验、M-WU检验、Kaplan-Meier及Cox回归分析对患者疗效及预后进行分析。另前瞻性入组Ⅲ期食管鳞癌患者42例进行结果验证。结果在视觉异质性评分中,操作者间评分高度一致,Kappa值为0.87。SUV等半定量参数不能预测患者疗效及生存,P>0.05;仅SUVmean是患者复发的独立危险因素,HR=2.19,P=0.027。MTV（阈值为24.77cm3）、TLG（阈值为504.35g）在预测疗效方面存在价值,曲线下面积（area under curve,AUC）分别为0.74、0.75。在预后方面,MTV、TLG是患者复发的独立危险因素,HR分别为2.06和1.97,均P值<0.05;仅MTV是患者生存的独立危险因素,HR=2.15,P=0.042。在疗效预测方面,以视觉异质性评分≤2为阈值,疗效预测效能最佳,AUC为0.75,灵敏度为75.6%（34/45）,特异度为66.7%;但其在预测生存方面各异质性分组间均差异无统计学意义,P>0.05。结论在Ⅲ期食管癌¹⁸F-FDG PET图像异质性分析中,视觉异质性评分具有预测患者疗效的潜力,但在预后方面能力局限。更多还原

【Abstract】 OBJECTIVE ¹⁸F-FDG PET imaging heterogeneity is an important method of tumor heterogeneity analysis,as tumor heterogeneity is closely related to the tumor response and survival of radiotherapy and chemotherapy.This study aims to investigate whether the visual heterogeneity score of ¹⁸F-FDG PET can predict tumor response and prognosis of stage Ⅲ esophageal squamous cell carcinoma.METHODS The enrolled 66 patients with stage Ⅲ esophageal squamous cell carcinoma who underwent ¹⁸F-FDG PET/CT imaging were retrospectively reviewed.The primary tumor heterogeneity was evaluated independently by two nuclear physicians based on visual heterogeneity classification（1=homogeneous,2=moderate heterogeneity,3=highly heterogeneity）.Metabolic parameters（SUVs,metabolic tumor volume,total lesion glycolysis）for the primary lesions were calculated on the ¹⁸F-FDG PET/CT image.Kappa analysis was used to compare the differences between the observers.Pearson chi-square test,M-WUtest,Kaplan-Meier and Cox regression analysis were used to analyze the response and prognosis of the patients.An additional 42 patients with stageⅢesophageal squamous cell carcinoma were collected as a test set to validate the results.RESULTS In the visual heterogeneity score,interobserver agreement reached a highly satisfactory level（Kappa value was 0.87）.SUVs parameters showed no significant associations with tumor response and survival,only SUVmean was an independent risk factor for tumor response（HR=2.19,P=0.027）.MTV（threshold 24.77 cm3）,TLG（threshold 504.35 g）were showed significant associations with tumor response,AUC were 0.74 and 0.75.In the prognosis,MTV and TLG were independent factors（HR=2.06,1.97,P<0.05）.Only MTV was an independent risk factor for survival（HR=2.15,P=0.042）.In the prediction of tumor response,when use visual heterogeneity score≤2 as the threshold,it demonstrated better results[AUC 0.75,sensitivity 75.6%（34/45）,specificity 66.7%（14/21）].There was no statistically significant difference between heterogeneous groups in predicting survival.CONCLUSION In the ¹⁸F-FDG PET image heterogeneity analysis,Hvisu can predict tumor response,but has limited value in prediction of prognosis of patients with stageⅢ esophageal cancer.更多还原