乳癌病患腫瘤與淋巴結在雙時相氟化去氧葡萄糖正子造影之攝取值和預後參數之相關性

Correlations between tumor and lymph node uptakes on dual-phased FDG PET/CT and prognostic parameters in breast cancer

張晉銓(Chin-Chuan Chang)

指導教授 ： 侯明鋒

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2015年)

摘要

乳癌病患治療前完整而精確的評估相當重要，因為這決定了病患後續的處置方法。以氟化去氧葡萄糖為放射藥物之正子電腦斷層掃描，臨床上已經廣泛使用作為乳癌病患的治療前評估。而臨床上除了傳統行之多年的臨床腫瘤分期（即TNM分期）外，目前已知有諸多預後因子，可以協助選擇適合的治療藥物並預測病患的預後。
本研究回朔查找乳癌病患病歷，紀錄病人腫瘤和淋巴結在雙時相氟化去氧葡萄糖正子電腦斷層攝影上的攝取值，並計算出保留指數（retention index），以統計軟體將這些造影所得參數與臨床上和生物上的預後因子（包括腫瘤大小、細胞分化、淋巴結狀態、遠端轉移、臨床分期、雌激素受體、黃體激素受體、人類表皮生長因子受體2和p53蛋白）做相關性探討。
共有32位病人的資料納入分析。結果顯示腫瘤的大小與分化和腫瘤針對氟化去氧葡萄糖的攝取值呈現達到統計差異的正相關。而淋巴結的攝取值和淋巴結狀態、遠端轉移和臨床分期有相關。在生物上的預後因子方面，最顯著的相關性在於腫瘤細胞人類表皮生長因子受體2的表現量和腫瘤與淋巴結之保留指數。本結果顯示腫瘤和淋巴結的氟化去氧葡萄糖攝取值與某些臨床和生物參數確實呈現相關性，正子造影或許可以做為乳癌細胞生物表現的預測因子。

關鍵字

雙時相 ； 正子斷層攝影 ； 乳癌 ； 預後因子 ； 保留指數

並列摘要

Precise evaluation for a breast cancer patient before treatment is very import because it may influence the following clinical managements. The positron emission tomography (PET), using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) as a radiopharmaceutical, has been clinically widely used for pretreatment evaluation for patients with breast cancer. Besides traditional TNM staging, there are many known prognostic parameters that may influence therapeutic decisions, help to chose an appropriate strategies and predict patients' prognosis.
In this study, patients with newly diagnosed breast cancer who had received a dual-phased FDG positron emission tomography/computed tomography scan for pretreatment staging were enrolled retrospectively. Maximal standardized uptake values at 1 h (SUV1), 2 h (SUV2), and retention indices (RI) of the tumors and ipsilateral axillary lymph nodes were measured. SUV and RI were compared with clinical and biological prognostic parameters (including tumor size, histological grade, lymph nodes status, distant metastasis, clinical stage, expression status of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 and p53 protein) via statistical analysis.
A total of 32 patients participated in the study. Tumor FDG uptake correlated with histological grade and tumor size. FDG uptake in axillary lymph nodes correlated positively with lymph node status, metastasis status and clinical stage. RI values for the tumor and lymph nodes were significantly positively correlated with human epidermal growth factor receptor-2 positivity. This study may draw a conclusion that FDG uptake in tumors and lymph nodes showed correlations with some clinical and biological parameters. And thus the FDG uptake may serve as a predictive marker of tumor biological behavior in breast cancer.

並列關鍵字

dual-phased ； positron emission tomography/computed tomography ； breast cancer ； prognostic parameter ； retention index

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