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研究生:陳朝榮
研究生(外文):Chen, Chaojung
論文名稱:評估18F-FDG最大標準攝取值為大腸直腸癌預後因子之研究
論文名稱(外文):Evaluation Of 18F-FDG Maximal Standardized Uptake Value As A Prognostic Factor In Colorectal Cancer
指導教授:陳泰賓陳泰賓引用關係丁慧枝
指導教授(外文):Chen, TaibeenDing, Hueishjy
口試委員:陳泰賓丁慧枝黃詠暉杜維昌
口試委員(外文):Chen, TaibeenDing, HueishjyHuang, YunghuiDu, Weichang
口試日期:2012-06-01
學位類別:碩士
校院名稱:義守大學
系所名稱:資訊工程學系碩士在職專班
學門:工程學門
學類:電資工程學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:英文
論文頁數:47
中文關鍵詞:氟化去氧葡萄糖正子電腦斷層最大標準攝取值大腸直腸癌生存復發
外文關鍵詞:18F-FDG PETSUVmaxColorectal CancerSurvivalRecurrence
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目的: 最近的研究已經證明原發腫瘤的最大標準攝取值在多種惡性腫瘤可當成預後因子。本研究的目的是確認大腸直腸癌患者術前原發腫瘤的最大標準攝取值是否能成為預後因子。
方法: 回顧性從2005年12月到2011年5月收集手術切除大腸直腸癌的患者。患者需手術前2週有做氟化去氧葡萄糖正子電腦斷層掃描。所有患者被分為無遠處轉移和有遠處轉移兩組。病人的所有臨床,病理,影像數據都被收集。原發腫瘤的最大標準攝取值以及腫瘤復發和病人死亡的日期都被記錄。
結果: 總共有222位病人被收入到本研究。其中,無遠處轉移患者有161例。在單變量分析中,最大標準攝取值、腫瘤大小、淋巴結轉移和淋巴血管侵犯皆是無病存活的獨立預後因子。然而在多變量分析中,它們都變得不顯著。以10為最大標準攝取值的分界,在對數等級檢定的無病存活分析中可達到最大的顯著性差異。此外,在無遠處轉移患者中只有11位病人在追蹤期間死亡。由於死亡人數太少,最大標準攝取值和整體存活之間的關聯無法被評估。在有遠處轉移患者中,共有61例患者被收入。在單變量分析中,最大標準攝取值、遠處轉移狀態以及腫瘤胚胎抗原指數皆是整體存活的獨立預後因子。在多變量分析中,最大標準攝取值和遠處轉移狀態仍然呈現顯著。以12.8為最大標準攝取值的分界,在對數等級檢定的整體存活分析中可達到最大的顯著性差異。
結論: 原發性腫瘤術前的最大標準攝取值在無遠處轉移患者的無病存活和有遠處轉移患者的整體存活中可當成大腸癌患者的預後因子。因此可能可以根據術前的最大標準攝取值給予病人不同的照護。
Purpose: Recent studies have demonstrated maximal standardized uptake value (SUVmax) in primary tumor as a prognostic factor in a variety of malignancy. The purpose of the study is to determine whether the preoperative SUVmax of primary tumor can be a prognostic factor in patients with colorectal cancer.
Methods: We retrospectively collected the data from patients primarily treated with surgical resection for colorectal cancer between December 2005 and May 2011. Patients were required to have undergone preoperative integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging during the 2 weeks before surgery. All patients were separated into two groups, including M0 (i.e. without distant metastasis) and M1 (i.e. with distant metastasis). All clinical, histological, and imaging data were collected. The SUVmax of primary tumor was recorded as well as the date of tumor recurrence and patient death.
Results: Total 222 patients were collected in the study. In M0 patients, total 161 patients were included. In the univariate analysis, the SUVmax (p=0.041), tumor size (p=0.005), lymph node metastasis (p=0.002), and lymphovascular invasion (p=0.013) were significantly associated with the disease-free survival. However, all of them became non-significant in the multivariate analysis. Using 10 as a cutoff of SUVmax, it showed a significant difference in the association with the disease-free survival from the log-rank test (p<0.05). Only 11 (6.8%) patients expired during the follow-up periods in the M0 patients. The association between SUVmax and the overall survival, therefore, cannot be assessed due to too limited number of death. In M1 patients, total 61 patients were recruited. In the univariate analysis, the SUVmax (p=0.047), M status (i.e. metastasis status)(p=0.008), and carcinoembryonic antigen level (p=0.036) were significantly associated with the overall survival. In the multivariate analysis, SUVmax (p=0.045) and M status (p=0.009) were still significant. According to a cutoff of SUVmax as 12.8, it showed a significant difference in the association with the overall survival from the log-rank test (p<0.05).
Conclusion: Preoperative SUVmax of primary tumor is a significant prognostic factor for disease-free survival in M0 patients and for overall survival in M1 patients in colorectal cancer. It may offer individual patient care according to the preoperative SUVmax.
Acknowledgments i
中文摘要ii
Abstract iii
Index iv
Tables vi
Figures vii
Chapter 1 Introduction 1
1-1 Background 1
1-2 Research motivation 3
Chapter 2 Materials and methods 4
2-1 Literature search 4
2-2 Subjects 5
2-3 18F-FDG PET/CT 6
2‐4 Histological analysis and clinical evaluation 7
2-5 Postoperative chemotherapy and radiotherapy 8
2-6 Image analysis 9
2-7 Statistical analysis 10
Chapter 3 Results 11
3-1 Patient characteristics11
3-2 M0 patients 14
3-3 M1 patients 19
Chapter 4 Discussion 22
4‐1 SUVmax as a prognostic factor in patients with colorectal cancer 22
4-2 SUVmax and tumor size in M0 patients 27
4-3 CEA level 28
4-4 Limitation 29
Chapter 5 Conclusion 30
References 31
Tables
Table 1 Patient characteristics and histological findings in M0 patients 11
Table 2 Patient characteristics and histological findings in M1 patients 12
Table 3 Results of analyses of prognostic factors for disease-free survival in M0 patients 15
Table 4 Results of analyses of prognostic factors for overall survival in M1 patients 19
Figures
Figure 1 Disease-free survival among patients separated by SUVmax in M0 patients 17
Figure 2 Disease-free survival among patients separated by tumor size in M0 patients 18
Figure 3 Overall survival among patients separated by SUVmax in M1 patients 20
Figure 4 A M0 patient with SUVmax of primary tumor as 7.4 23
Figure 5 A M0 patient with SUVmax of primary tumor as 13.9 24
Figure 6 A M1 patient with SUVmax of primary tumor as 6.8 25
Figure 7 A M1 patient with SUVmax of primary tumor as 16.2 26
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