乳腺癌分子生物学指标与18F-FDG PET-CT SUVmax的相关性研究

Correlations of 18F-FDG PET-CT SUVmax with molecular biological markers of breast cancer

摘要:

目的比较乳腺癌新辅助化疗18F-FDG正电子发射计算机断层显像（PET-CT）最大标准摄取值（SUVmax）、第一疗程化疗后SUVmax变化率（⊿SUVmax 1%）、第二疗程化疗后SUVmax 变化率（⊿SUVmax 2%）与雌激素受体（ER）、孕激素受体（PR）、表皮生长因子受体-2（HER-2）、Ki-67、p53 表达的关系，探讨乳腺癌新辅助化疗中氟代脱氧葡萄糖（FDG）代谢与乳腺癌分子生物学指标的内在联系。方法完成新辅助化疗前18F-FDGPET-CT 患者211 例，完成第1 次化疗后PET-CT 患者49 例，完成第2 次化疗后PET-CT 患者49 例，测量每次的SUVmax并计算其变化率，在新辅助化疗前取乳腺肿瘤组织进行ER、PR、HER-2、Ki-67及p53免疫组织化学法检查。结果ER 表达阴性组的SUVmax高于ER 表达阳性组（P <0.05）。PR 表达阴性组的SUVmax高于PR 表达阳性组（p <0.05）。PR表达阴性组的⊿SUVmax 2%高于PR表达阳性组（p <0.05）。Ki-67 表达阳性组的SUVmax、⊿SUVmax 2%高于Ki-67 表达阴性组（ p<0.05）。结论ER、PR 阴性患者FDG 代谢要高于ER、PR 表达阳性患者。PR 阴性患者⊿SUVmax 2%高于PR阳性患者，提示PR阴性患者对化疗更敏感。Ki-67 阳性的患者SUVmax高于Ki-67 阴性患者，提示FDG 代谢能一定程度反映乳腺癌的增殖活跃程度。Ki-67 阳性的患者有较高的⊿SUVmax 2%，提示Ki-67 阳性患者对化疗更加敏感。

Abstract:

Objective To explore the intrinsic links between FDG uptake in neoadjuvant chemotherapy and molecular biological markers of breast cancer. Methods In this study, 211 patients with newly-diagnosed breast cancer completed 18F-FDG PET-CT before neoadjuvant chemotherapy, 49 cases completed PET-CT after the first course of neoadjuvant chemotherapy, 49 cases cases completed PET-CT after the second course of neoadjuvant chemotherapy. SUVmax was measured everytime and the rate of change was calculated. Before neoadjuvant chemotherapy, breast cancer tissues were taken for ER, PR, HER -2, Ki -67 and p53 immumohistochemical examination. The correlations of SUVmax, ⊿ SUVmax 1% and ⊿ SUVmax 2% with the expressions of ER, PR, HER-2, Ki-67 and p53 in breast cancer were analyzed. Results SUVmax in the ERnegative group was significantly higher than that in the ER-positive group (p < 0.05). SUVmax in the PRnegative group was significantly higher than that in the PR-positive group (p < 0.05). ⊿SUVmax 2% in the PR-negative group was higher than that in the PR-positive group (p < 0.05). SUVmax and ⊿SUVmax 2% in the Ki-67-positive group were higher than those in the Ki-67-negative group (p < 0.05). Conclusions FDG metabolism in ER and PR negative patients is higher than that in ER and PR positive patients. ⊿SUVmax 2% in PR negative patients is higher than that in PR positive patients, suggesting that PR negative patients are more sensitive to neoadjuvant chemotherapy. SUVmax of Ki-67 positive patients is higher than that of Ki-67 negative patietns, suggesting FDG metabolism may reflect the proliferative degree of breat cancer. Ki -67 positive patients have a higher ⊿SUVmax 2%, which means Ki-67 positive patients are more sensitive to neoadjuvant chemotherapy.