Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer
Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer
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DOI：
10.2967/jnumed.113.127340
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发表时间：
2014-06-01
影响因子：
9.3
通讯作者：
Essler, Markus
中科院分区：
文献类型：
--
作者：
Bundschuh, Ralph A.;Dinges, Julia;Essler, Markus
F-18-FDG PET/CT可有效评估治疗反应。葡萄糖摄取或肿瘤大小的变化用作量度。肿瘤异质性被认为是一个有前途的预测和预后因素。我们以组织病理学为金标准，研究了纹理参数对直肠癌患者的预测和预后能力。此外，还与临床结局进行了比较。研究方法：27例直肠癌患者在新辅助放化疗前、开始后2周和完成后4周接受了F-18-FDG PET/CT检查。在所有PET/CT扫描中，确定常规参数（肿瘤体积、直径、最大和平均标准化摄取值和总病变糖酵解[TLG]）和纹理参数（变异系数[Coy]、偏度和峰度），以评估肿瘤异质性。将治疗前PET/CT值以及治疗过程中早期和治疗后的变化与组织病理学反应进行比较。此外，通过与进展时间和生存时间的相关性评估预后价值。结果如下：COV在治疗早期（敏感性，68%;特异性，88%）和治疗后（分别为79%和88%）评估组织病理学反应的能力具有统计学意义。因此，COV在受试者操作特征分析中的曲线下面积高于早期和晚期反应评估的任何分析的常规参数。COV显示了统计学显著的评估疾病进展和预测生存的能力，尽管后者没有统计学显著性。总结：COV评估的肿瘤异质性比传统参数有上级的优势，是直肠癌患者的一个重要预测因素。此外，它还可以提供预后信息。因此，它的应用是直肠癌个性化治疗的重要一步。
F-18-FDG PET/CT is effective in the assessment of therapy response. Changes in glucose uptake or tumor size are used as a Measure. Tumor heterogeneity was found to be a promising predictive and prognostic factor. We investigated textural parameters for their predictive and prognostic capability in patients with rectal cancer using histopathology as the gold standard. In addition, a comparison to clinical outcome was performed. Methods: Twenty-seven patients with rectal cancer underwent F-18-FDG PET/CT before, 2 wk after the start, and 4 wk after the completion of neoadjuvant chemoradiotherapy. In all PET/CT scans, conventional parameters (tumor volume, diameter, maximum and mean standardized uptake values, and total lesion glycolysis [TLG]) and textural parameters (coefficient of variation [Coy], skewness, and kurtosis) were determined to assess tumor heterogeneity. Values on pretherapeutic PET/CT as well as changes early in the course of therapy and after therapy were compared with histopathologic response. In addition, the prognostic value was assessed by correlation with time to progression and survival time. Results: The COV showed a statistically significant capability to assess histopathologic response early in therapy (sensitivity, 68%; specificity, 88%) and after therapy (79% and 88%, respectively). Thereby, the COV had a higher area under the curve in receiver-operating-characteristic analysis than did any analyzed conventional parameter for early and late response assessment. The COV showed a statistically significant capability to evaluate disease progression and to predict survival, although the latter was not statistically significant. Conclusion: Tumor heterogeneity assessed by the COV, being superior to the investigated conventional parameters, is an important predictive factor in patients with rectal cancer. Furthermore, it can provide prognostic information. Therefore, its application is an important step for personalized treatment of rectal cancer.