治疗前<sup>18</sup>F-FLT和<sup>18</sup>F-FDG PET/CT摄取异质性在局部晚期鼻咽癌疗效预测中的价值

马光; 区晓敏; 胡超苏; 宋少莉; 杨忠毅

doi:10.19401/j.cnki.1007-3639.2022.04.003

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治疗前¹⁸F-FLT和¹⁸F-FDG PET/CT摄取异质性在局部晚期鼻咽癌疗效预测中的价值

论著 | 更新时间：2025-12-31

- 治疗前¹⁸F-FLT和¹⁸F-FDG PET/CT摄取异质性在局部晚期鼻咽癌疗效预测中的价值
- Value of pretreatment ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma
- 中国癌症杂志 2022年32卷第4期页码：309-315
- 作者机构：
  
  1. 复旦大学附属肿瘤医院核医学科,复旦大学上海医学院肿瘤学系,复旦大学生物医学影像研究中心,上海分子影像探针工程技术研究中心 200032
  2. 复旦大学附属肿瘤医学放疗科、复旦大学上海医学院肿瘤学系 200032
- 作者简介：
  
  [ "马光（ORCID: 0000-0003-4787-201X）,硕士,主治医师 E-mail: 18121299445@163.com" ]
  杨忠毅（ORCID: 0000-0001-6195-9942）,博士,副主任医师,复旦大学附属肿瘤医院核医学科主任助理 E-mail: yangzhongyi21@163.com
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.04.003
  中图分类号： R739.6
- 收稿：2021-11-30，
  
  修回：2022-02-22，
  
  纸质出版：2022-04-30
- 稿件说明：
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马光, 区晓敏, 胡超苏, 等. 治疗前¹⁸F-FLT和¹⁸F-FDG PET/CT摄取异质性在局部晚期鼻咽癌疗效预测中的价值[J]. 中国癌症杂志, 2022,32(4):309-315.

Guang MA, Xiaomin OU, Chaosu HU, et al. Value of pretreatment ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma[J]. China Oncology, 2022, 32(4): 309-315.
马光, 区晓敏, 胡超苏, 等. 治疗前¹⁸F-FLT和¹⁸F-FDG PET/CT摄取异质性在局部晚期鼻咽癌疗效预测中的价值[J]. 中国癌症杂志, 2022,32(4):309-315. DOI： 10.19401/j.cnki.1007-3639.2022.04.003.

Guang MA, Xiaomin OU, Chaosu HU, et al. Value of pretreatment ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma[J]. China Oncology, 2022, 32(4): 309-315. DOI： 10.19401/j.cnki.1007-3639.2022.04.003.

摘要

背景与目的：

鼻咽癌是东南亚地区常见的头颈部恶性肿瘤之一

对于局部晚期鼻咽癌患者来说

放疗联合化疗为主要治疗方式

但不同患者间治疗反应存在个体差异。因此

早期准确评估局部晚期鼻咽癌放化疗预后能力对于临床治疗决策的制定具有重要意义。本研究评估和比较治疗前

F-胸苷（fluorothymidine

FLT）、

F-脱氧葡萄糖（fluorodeoxyglucose

FDG）正电子发射断层显像/X线计算机体层成像仪（positron emission tomography/computed tomography

PET/CT）显像参数在局部晚期鼻咽癌患者放化疗预后预测中的价值。

方法：

回顾性分析复旦大学附属肿瘤医院2012年5月

#x02014;2015年1月局部晚期鼻咽癌患者

所有患者均接受新辅助化疗（neoadjuvant chemotherapy

NACT）及调强放射治疗（intensity-modulated radiation therapy

IMRT）。随访结点为无进展生存期（progression-free survival

PFS）

定义为从治疗开始至肿瘤进展或者发生任何原因死亡的时间。病灶评估依据实体瘤疗效评价标准1.1（Response Evaluation Criteria in Solid Tumor 1.1

RECIST 1.1）。所有患者均于治疗前分别行

F-FLT 和

F-FDG PET/CT显像

两次显像时间间隔均保持在1周以内

并测量其主要参数

包括：最大标准化摄取值（maximal standardized uptake value

SUV

max

）、平均标准化摄取值（mean standardized uptake value

SUV

mean

）、增殖性肿瘤体积（proliferative tumor volume

PTV）/代谢性肿瘤体积（metabolic tumor volume

MTV）、病灶腺苷代谢总量（total lesion thymidine

TLT）/病灶葡萄糖代谢总量（total lesion glucose

TLG）及肿瘤异质性（heterogeneity index

HI）。采用Spearman等级相关系数分析上述PET/CT参数与局部晚期鼻咽癌患者转移/复发的相关性。随后

采用受试者工作特征（receiver operating characteristic

ROC）曲线筛选最佳界值

并评价其预测效能。同时建立Kaplan-Meier模型绘制生存曲线

并采用log-rank检验进行比较。

结果：

24例局部晚期鼻咽癌患者中

复发或转移共6例

中位随访时间为74.51个月。Spearman等级相关系数分析结果显示

仅在

F-FLT PET/CT显像组中

以70%SUV

max

为阈值测得原发灶肿瘤内异质性

指数

即HI

（T-FLT-70%SUVmax）

与肿瘤转移/复发具有相关性（

=0.04）;ROC曲线分析显示其HI

（T-FLT-70%SUVmax）

预测转移/复发的灵敏度为80.00%

特异度为79.90%（

=0.043）

生存分析结果显示当HI

（T-FLT-70%SUVmax）

0.828时

其中位PFS为57.99个月

明显短于HI

（T-FLT-70%SUVmax）

#x02264;0.828的患者（

=0.014）。

结论：

基于

F-FLT PET/CT显像的肿瘤内HI具有预测局部晚期鼻咽癌放化疗效果的潜在价值。

Abstract

Background and purpose:

Nasopharyngeal carcinoma is one of the most common head and neck malignancies in Southeast Asia. Radiotherapy combined with chemotherapy is the main treatment for patients with locally advanced nasopharyngeal carcinoma (LANPC)

however

different patients have various levels of clinical benefit. Therefore

early and accurate evaluation of the prognosis of LANPC after radiotherapy and chemotherapy is of great significance for clinical treatment decision-making. This paper aimed to evaluate and compare the value of

F-Fluorothymidine (FLT) and

F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging parameters in predicting the prognosis of patients with LANPC after radiotherapy and chemotherapy.

Methods:

Patients with LANPC who all received intensity-modulated radiation therapy (IMRT) and neoadjuvant chemotherapy (NACT) in Fudan University Shanghai Cancer Center from May 2012 to January 2015 were retrospectively selected. Clinical follow-up endpoint was progression-free survival (PFS)

defined as the time from the beginning of treatment to tumor progression or death from any cause. The focus evaluation was based on the Response Evaluation Criteria in Solid Tumor 1.1 (RECIST 1.1). Pretreatment

F-FLT and

F-FDG PET/CT imaging were performed respectively. And the time interval between the two imaging was maintained within 1 week. The main parameters were measured

including maximal standardized uptake value (SUV

max

)

mean standardized uptake value (SUVmean)

proliferative tumor volume (PTV)/metabolic tumor volume (MTV)

total lesion thymidine (TLT)/ total lesion glucose (TLG) and tumor heterogeneity index (HI). Spearman rank correlation coefficient was used to analyze the correlation between the above PET/CT parameters and patients with metastasis/recurrence of LANPC. Then

the best cut-off value was determined by the receiver operating characteristic (ROC) curve

and the predictive ability was evaluated by the ROC curve. PFS was evaluated by the Kaplan-Meier method and log-rank test.

Results:

Among the 24 patients

6 had metastasis or recurrence. The median follow-up time was 74.51 months. Spearman rank correlation coefficient analysis showed that HI

(T-FLT-70%SUVmax)

was associated with metastasis or recurrence (

=0.04); ROC curve analysis showed that the sensitivity of HI

(T-FLT-70%SUVmax)

in predicting metastatic or recurrent nasopharyngeal carcinoma was 80.00%

and the specificity was 79.90% (

=0.043). Survival analysis showed that when HI

(T-FLT-70%SUVmax)

0.828

the median PFS was 57.99 months

which was significantly shorter compared with patients with HI

(T-FLT-70%SUVmax)

#x02264;0.828 (

=0.014).

Conclusion:

HI based on

F-FLT PET/CT may be useful for predicting the prognosis of patients with LANPC receiving radiotherapy and chemotherapy.

关键词

Keywords

references

WEE C W , KEAM B , HEO D S , et al . Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy [J ] . Radiat Oncol J , 2015 , 33 ( 2 ): 98 - 108 . DOI: 10.3857/roj.2015.33.2.98 http://doi.org/10.3857/roj.2015.33.2.98 http://e-roj.org/journal/view.php?doi=10.3857/roj.2015.33.2.98 http://e-roj.org/journal/view.php?doi=10.3857/roj.2015.33.2.98

LIN J C , JAN J S , HSU C Y , et al . Phase Ⅲ study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival [J ] . J Clin Oncol , 2003 , 21 ( 4 ): 631 - 637 . DOI: 10.1200/JCO.2003.06.158 http://doi.org/10.1200/JCO.2003.06.158 http://ascopubs.org/doi/10.1200/JCO.2003.06.158 http://ascopubs.org/doi/10.1200/JCO.2003.06.158

CHAN A T , LEUNG S F , NGAN R K , et al . Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma [J ] . J Natl Cancer Inst , 2005 , 97 ( 7 ): 536 - 539 . DOI: 10.1093/jnci/dji084 http://doi.org/10.1093/jnci/dji084 https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/dji084 https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/dji084

ZHANG L , ZHAO C , GHIMIRE B , et al . The role of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma among endemic population: a meta-analysis of the phase Ⅲ randomized trials [J ] . BMC Cancer , 2010 , 10 : 558 . DOI: 10.1186/1471-2407-10-558 http://doi.org/10.1186/1471-2407-10-558 https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-10-558 https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-10-558

KHAN N , ISLAM M M , MAHMOOD S , et al . 18 F-fluorodeoxyglucose uptake in tumor [J ] . Mymensingh Med J , 2011 , 20 ( 2 ): 332 - 342 .

PECK M , POLLACK H A , FRIESEN A , et al . Applications of PET imaging with the proliferation marker[ 18 F ] -FLT [J ] . Q J Nucl Med Mol Imaging , 2015 , 59 ( 1 ): 95 - 104 .

CHRISTENSEN T N , LANGER S W , PERSSON G , et al . 18 F-FLT PET/CT adds value to 18 F-FDG PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer: results of a prospective clinical trial [J ] . J Nucl Med , 2021 , 62 ( 5 ): 628 - 635 . DOI: 10.2967/jnumed.120.247742 http://doi.org/10.2967/jnumed.120.247742 http://jnm.snmjournals.org/lookup/doi/10.2967/jnumed.120.247742 http://jnm.snmjournals.org/lookup/doi/10.2967/jnumed.120.247742

GERBAUDO V H , KILLORAN J H , KIM C K , et al . Pilot study of serial FLT and FDG-PET/CT imaging to monitor response to neoadjuvant chemoradiotherapy of esophageal adenocarcinoma: correlation with histopathologic response [J ] . Ann Nucl Med , 2018 , 32 ( 3 ): 165 - 174 . DOI: 10.1007/s12149-018-1229-0 http://doi.org/10.1007/s12149-018-1229-0 https://doi.org/10.1007/s12149-018-1229-0 https://doi.org/10.1007/s12149-018-1229-0

RACCAGNI I , BELLOLI S , VALTORTA S , et al . [ 18 F ] FDG and [ 18 F ] FLT PET for the evaluation of response to neo-adjuvant chemotherapy in a model of triple negative breast cancer [J ] . PLoS One , 2018 , 13 ( 5 ): e0197754.

CEGŁA P , BURCHARDT E , CHOLEWIŃSKI W , et al . Comparison of semiquantitative metabolic parameters of the primary tumor obtained in PET/CT with 18 F-FDG and 18 F-FLT in patients with cervical cancer [J ] . Nuklearmedizin , 2020 , 59 ( 3 ): 241 - 247 . DOI: 10.1055/a-1084-4766 http://doi.org/10.1055/a-1084-4766 http://www.thieme-connect.de/DOI/DOI?10.1055/a-1084-4766 http://www.thieme-connect.de/DOI/DOI?10.1055/a-1084-4766

SHI Q , YANG Z Y , ZHANG Y J , et al . 18 F-FLT and 18 F-FDG PET/CT in predicting response to chemoradiotherapy in nasopharyngeal carcinoma: preliminary results [J ] . Sci Rep , 2017 , 7 : 40552 . DO I: 10.1038/srep40552 http://doi.org/10.1038/srep40552 https://doi.org/10.1038/srep40552 https://doi.org/10.1038/srep40552

GONG C C , MA G , HU X C , et al . Pretreatment 18 F-FDG uptake heterogeneity predicts treatment outcome of first-line chemotherapy in patients with metastatic triple-negative breast cancer [J ] . Oncologist , 2018 , 23 ( 10 ): 1144 - 1152 . DOI: 10.1634/theoncologist.2018-0001 http://doi.org/10.1634/theoncologist.2018-0001 https://academic.oup.com/oncolo/article/23/10/1144/6439767 https://academic.oup.com/oncolo/article/23/10/1144/6439767

MA G , GU B X , HU J Y , et al . Pretreatment 18 F-FDG uptake heterogeneity can predict treatment outcome of carbon ion radiotherapy in patients with locally recurrent nasopharyngeal carcinoma [J ] . Ann Nucl Med , 2021 , 35 ( 7 ): 834 - 842 . DOI: 10.1007/s12149-021-01621-8 http://doi.org/10.1007/s12149-021-01621-8 https://doi.org/10.1007/s12149-021-01621-8 https://doi.org/10.1007/s12149-021-01621-8

TELLO GALÁN M J , GARCÍA VICENTE A M , PÉREZ BETETA J , et al . Global heterogeneity assessed with 18 F-FDG PET/CT. Relation with biological variables and prognosis in locally advanced breast cancer [J ] . Rev Esp Med Nucl Imagen Mol (Engl Ed ), 2019 , 38 ( 5 ): 290 - 297 .

HU J Y , YANG Z Y , GAO J , et al . Volumetric parameters derived from FLT-PET performed at completion of treatment predict efficacy of carbon-ion radiotherapy in patients with locally recurrent nasopharyngeal carcinoma [J ] . J Cancer , 2020 , 11 ( 23 ): 7073 - 7080 . DOI: 10.7150/jca.46490 http://doi.org/10.7150/jca.46490 https://www.jcancer.org/v11p7073.htm https://www.jcancer.org/v11p7073.htm

LI Y C , ZHANG Y , FANG Q , et al . Radiomics analysis of [ 18 F ] FDG PET/CT for microvascular invasion and prognosis prediction in very-early- and early-stage hepatocellular carcinoma [J ] . Eur J Nucl Med Mol Imaging , 2021 , 48 ( 8 ): 2599 - 2614 . DOI: 10.1007/s00259-020-05119-9 http://doi.org/10.1007/s00259-020-05119-9 https://doi.org/10.1007/s00259-020-05119-9 https://doi.org/10.1007/s00259-020-05119-9

LIU J , YANG X , YANG J G . Prognosis predicting value of semiquantitative parameters of visceral adipose tissue and subcutaneous adipose tissue of 18 F-FDG PET/CT in newly diagnosed secondary hemophagocytic lymphohistiocytosis [J ] . Ann Nucl Med , 2021 , 35 ( 3 ): 386 - 396 . DOI: 10.1007/s12149-021-01577-9 http://doi.org/10.1007/s12149-021-01577-9 https://doi.org/10.1007/s12149-021-01577-9 https://doi.org/10.1007/s12149-021-01577-9

ABBASI F , JALILI M , SAMAEI M R , et al . Effect of land use on cultivable bioaerosols in the indoor air of hospital in southeast Iran and its determination of the affected radius around of hospital [J ] . Environ Sci Pollut Res Int , 2021 , 28 ( 10 ): 12707 - 12713 . DOI: 10.1007/s11356-020-10357-3 http://doi.org/10.1007/s11356-020-10357-3 https://doi.org/10.1007/s11356-020-10357-3 https://doi.org/10.1007/s11356-020-10357-3

NAKAJIMA R , NAGAO M , OHASHI R , et al . Modified fractal analysis of methionine positron emission tomography images for predicting prognosis in newly diagnosed patients with glioma [J ] . Nucl Med Commun , 2018 , 39 ( 12 ): 1165 - 1173 . DOI: 10.1097/MNM.0000000000000917 http://doi.org/10.1097/MNM.0000000000000917 https://journals.lww.com/00006231-201812000-00014 https://journals.lww.com/00006231-201812000-00014

NAKAJO M , KAJIYA Y , TANI A , et al . A pilot study for texture analysis of 18 F-FDG and 18 F-FLT-PET/CT to predict tumor recurrence of patients with colorectal cancer who received surgery [J ] . Eur J Nucl Med Mol Imaging , 2017 , 44 ( 13 ): 2158 - 2168 . DOI: 10.1007/s00259-017-3787-0 http://doi.org/10.1007/s00259-017-3787-0 http://link.springer.com/10.1007/s00259-017-3787-0 http://link.springer.com/10.1007/s00259-017-3787-0

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Value of pretreatment 18F-FLT PET/CT and 18F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma

DOI：10.19401/j.cnki.1007-3639.2022.04.003

摘要

Abstract

关键词

Keywords

references

治疗前¹⁸F-FLT和¹⁸F-FDG PET/CT摄取异质性在局部晚期鼻咽癌疗效预测中的价值

Value of pretreatment ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma