目的：探讨基线18F-FDGPET/CT对食管鳞状细胞癌（ESCC）行确定性（化疗）放疗的预后价值。
方法：回顾性分析2013年12月至2020年12月在18F-FDGPET/CT检查后接受确定性（化学）放疗的98例cTNM分期T1-4、N1-3、M0的ESCC患者。临床因素包括年龄，性别,组织学分化等级,肿瘤位置,临床分期,和治疗策略。通过18F-FDGPET/CT获得的参数包括原发肿瘤的SUVmax（SUVTuman），代谢性肿瘤体积（MTV），总病变糖酵解（TLG），淋巴结SUVmax(SUVLN),PET阳性淋巴结(PLNS)数,患者BSA标准化后，最远的PET阳性淋巴结与原发肿瘤在三维空间中的最短距离（SDmax（LN-T））。采用Cox比例风险模型进行单因素和多因素分析,探讨影响ESCC患者总生存期(OS)和无进展生存期(PFS)的重要因素。
结果：单因素分析显示，肿瘤位置，肿瘤，MTV,TLG,PLNS号码,SDmax(LN-T)是OS和肿瘤位置的重要预测因子，和临床T分期，肿瘤，MTV,TLG,SDmax(LN-T)是PFS的显著预测因子(所有p<0.1)。多因素分析显示，MTV和SDmax（LN-T）是OS（HR=1.018，95％CI1.006-1.031；p=0.005；HR=6.988，95％CI2.119-23.042；p=0.001）和PFS（HR=1.019，95％CI1.005-1.034；p=0.009；HR=5.819，95％CI1.921-0.00628p=0.00结合独立预后因素MTV和SDmax（LN-T），我们可以进一步对患者风险进行分层。
结论：治疗前，18F-FDGPET/CT对接受确定性（化学）放疗的ESCC患者具有重要的预后价值。MTV和SDmax(LN-T)值越低，患者预后越好。
OBJECTIVE: To investigate the prognostic value of baseline 18F-FDG PET/CT in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive (chemo)radiotherapy.
METHODS: A total of 98 ESCC patients with cTNM stage T1-4, N1-3, M0 who received definitive (chemo)radiotherapy after 18F-FDG PET/CT examination from December 2013 to December 2020 were retrospectively analyzed. Clinical factors included age, sex, histologic differentiation grade, tumor location, clinical stage, and treatment strategies. Parameters obtained by 18F-FDG PET/CT included SUVmax of primary tumor (SUVTumor), metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUVmax of lymph node (SUVLN), PET positive lymph nodes (PLNS) number, the shortest distance between the farthest PET positive lymph node and the primary tumor in three-dimensional space after the standardization of the patient BSA (SDmax(LN-T)). Univariate and multivariate analysis was conducted by Cox proportional hazard model to explore the significant factors affecting overall survival (OS) and progression-free survival (PFS) in ESCC patients.
RESULTS: Univariate analysis showed that tumor location, SUVTumor, MTV, TLG, PLNS number, SDmax (LN-T) were significant predictors of OS and tumor location, and clinical T stage, SUVTumor, MTV, TLG, SDmax (LN-T) were significant predictors of PFS (all p < 0.1). Multivariate analysis showed that MTV and SDmax (LN-T) were independent prognostic factors for OS (HR = 1.018, 95% CI 1.006-1.031; p = 0.005; HR = 6.988, 95% CI 2.119-23.042; p = 0.001) and PFS (HR = 1.019, 95% CI 1.005-1.034; p = 0.009; HR = 5.819, 95% CI 1.921-17.628; p = 0.002). Combined with independent prognostic factors MTV and SDmax (LN-T), we can further stratify patient risk.
CONCLUSIONS: Before treatment, 18F-FDG PET/CT has important prognostic value for patients with ESCC treated with definitive (chemo)radiotherapy. The lower the value of MTV and SDmax (LN-T), the better the prognosis of patients.
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