标题：乳腺癌EGFR表达与 18F-FDG PET/CT代谢参数间的相关性

      作者：彭新华，朱研佳，朱磊，徐文贵    天津医科大学肿瘤医院分子影像与核医学诊疗科、国家恶性肿瘤临床医学研究中心、天津市“肿瘤防治”重点实验室、天津市恶性肿瘤临床医学研究中心，乳腺癌防治教育部重点实验室，天津 300060

      卷次： 2022年33卷21期

      【摘要】 目的 分析乳腺癌表皮生长因子受体(EGFR)表达与 18F-FDG PET/CT代谢参数间的相关性，并评价18F-FDG PET/CT代谢参数对乳腺癌EGFR阳性表达的预测效能。方法 回顾性分析2015年 4月至2021年8月就诊于天津医科大学肿瘤医院的72例患者的临床资料，所有患者均于术前行 18F-FDG PET/CT检查并经病理证实为乳腺癌，测量原发灶最大标准化摄取值(SUVmax)、肿瘤代谢体积(MTV)、糖酵解总量(TLG)，分析EGFR表达状态与18F-FDG PET/CT代谢参数的相关性，通过受试者工作特征曲线(ROC)及Logistic回归分析评价原发灶 18F-FDG PET/CT显像代谢参数对EGFR阳性表达的预测效能。结果 72例患者中EGFR阳性表达者29例，阴性表达者43例，EGFR阳性表达率为40.28%；EGFR阳性表达者SUVmax、TLG中位数分别为11.97、227.48，明显高于阴性者的7.00、27.72，差异均有统计学意义(P<0.05)，MTV比较差异无统计学意义(P>0.05)；在肿瘤直径>5 cm、ER阴性、PR阴性、三阴性乳腺癌以及T3~4、Ⅲ~Ⅳ期中的EGFR阳性表达率明显高于肿瘤直径≤5 cm、ER阳性、PR阳性、非三阴性乳腺癌以及T1~2、Ⅰ~Ⅱ期的EGFR阳性表达率，差异均有统计学意义(P<0.05)；原发灶直径>5 cm、ER阴性、PR阴性、三阴性乳腺癌、T3~4、Ⅲ~Ⅳ期的SUVmax明显高于直径≤5 cm、ER阳性、PR阳性、非三阴性乳腺癌、T1~2、Ⅰ~Ⅱ期的SUVmax，差异均有统计学意义(P<0.05)；原发灶直径>5 cm、有淋巴结转移、T3~4、Ⅲ~Ⅳ期的MTV、TLG明显高于直径≤5 cm、无淋巴结转移、T1~2、Ⅰ~Ⅱ期的MTV、TLG，差异均有统计学意义(P<0.05)；原发灶SUVmax、TLG对EGFR阳性表达预测效能的ROC曲线下面积AUC分别为0.773、0.695；SUVmax最佳预测界值为13.95，灵敏度为51.7%，特异度为93.0%；TLG最佳预测界值207.48，灵敏度为51.7%，特异度为88.4%；Logistic回归分析结果显示，SUVmax为EGFR阳性表达的主要相关因素(P<0.05)。结论 不同临床病理特征乳腺癌患者的EGFR表达状态和代谢参数存在差异，且SUVmax、TLG与EGFR表达状态有关，对EGFR阳性表达具有良好的预测价值；SUVmax为EGFR阳性表达的主要相关因素；18F-FDGPET/CT代谢参数能一定程度够反映乳腺癌EGFR表达状态，在乳腺癌临床诊疗中具有参考价值。
      【关键词】 乳腺癌；表皮生长因子受体；氟代脱氧葡萄糖；正电子发射计算机断层扫描；临床病理特征；相关性
      【中图分类号】 R737.9 【文献标识码】 A 【文章编号】 1003—6350（2022）21—2806—05

Relationship between epidermal growth factor receptor expression and 18F-FDG PET/CT metabolism parametersin patients with breast cancer.
PENG Xin-hua, ZHU Yan-jia, ZHU Lei, XU Wen-gui. Department of Molecular Imagingand Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center forCancer; Key Laboratory of Cancer Prevention and Therapy of Tianjin; Tianjin’s Clinical Research Center for Cancer; KeyLaboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin 300060, CHINA
【Abstract】 Objective To explore the correlation between EGFR expression and 18F-fluorodeoxyglucose posi-tron emission computed tomography (18F-FDG PET/CT) metabolic parameters in patients with breast cancer, and to ana-lyze the predictive efficacy of 18F-FDG PET/CT metabolic parameters on the positive expression of EGFR in patientswith breast cancer.Methods The clinical data of 72 patients who were treated in Tianjin Medical University Cancer In-stitute and Hospital from April 2015 to August 2021 were retrospectively analyzed. All patients underwent 18F-FDG PET/CT examination before surgery and were pathologically confirmed to be breast cancer. According to PET/CT imaging da-ta, the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)of primary lesions were measured automatically. The correlation of EGFR expression status and 18F-FDG PET/CT meta-bolic parameters were analyzed, and the predictive performance of 18F-FDG PET/CT metabolic parameters of primary tu-mor on EGFR positive expression was evaluated by receiver operating characteristic curve (ROC curve) and Logistic re-gression analysis. Results Among the 72 patients, 29 had EGFR positive expression and 43 had negative expression,and the EGFR positive expression rate was 40.28%; the median values of SUVmax and TLG in patients with EGFR posi-tive expression were 11.97 and 227.48, which were significantly higher than 7.00 and 27.72 in patients with EGFR nega-tive expression (P<0.05); there was no significant difference in MTV (P>0.05). The EGFR positive expression rate in pa-tients with tumor diameter>5 cm, ER-negative, PR-negative, triple-negative breast cancer, T3~4, Ⅲ-Ⅳ stage was signifi-cantly higher than that in patients with tumor diameter≤5 cm, ER-positive, PR-positive, non-triple-negative breast can-cer, T1~2, Ⅰ-Ⅱ stage (P<0.05). The SUVmax of patients with tumor diameter>5 cm, ER-negative, PR-negative, triple-neg-ative breast cancer, T3~4, Ⅲ-Ⅳ stage was significantly higher than that of patients with diameter≤5 cm, ER-positive,