| Part one The value of 18F-FDG PET/CT imaging combined with tumor markers CEA、CA19-9 in postoperative recurrence of colorectal cancer.Objective: To investigate the value of 18F-FDG PET/CT combined with serum tumor markers CEA and CA19-9 in postoperative recurrence of colorectal cancer.The optimal cut-off of SUVmax,CEA and CA19-9 were also analyzed.Methods: A total of 28 patients with colorectal cancer after radical surgery were collected,followed by 18F-FDG PET/CT examination,and the serum CEA and CA19-9 levels were detected within a week.All of them were compared with the final results and the sensitivity,specificity,accuracy,positive predictive values and negative predictive values of the diagnosis,so done as 18F-FDG PET/CT combined CEA or/and CA19-9.SUVmax,CEA and CA19-9 were analysed for ROC curve to monitor the optimal cut-off for recurrence in colorectal cancer.Results: Of the 28 patients with colorectal cancer after radical surgery,16 cases were confirmed as recurrence and 12 cases had no recurrence.18F-FDG PET/CT imaging showed 17 positive cases(including 15 true positive cases and 2 false positives cases).For detecting postoperative recurrence of colorectal cancer,PET/CT yielded a sensitivity,specificity,accuracy,PPVs,NPVs were 93.8%,83.3%,89.3%,88.2% and 90.9%,respectively.The serum CEA level was tested positive for 16 cases(including 14 true positive cases and 2 false positives cases).There were 12 negative cases(including 10 true negative cases and 2 false negative cases).The sensitivity,specificity,accuracy,PPVs and NPVs were 87.5%,83.3%,85.7%,87.5% and 85.7%,respectively.The serum CA19-9 level was positive in 14 cases(including 13 ture positive cases and1 false positive cases).There were 14 negative cases(11 of them were ture negative and 3 were false negative).The sensitivity,specificity,accuracy,PPVs and NPVs are 81.3%,91.7%,85.7%,92.9% and 78.6%,respectively.The sensitivity of combined PET/CT and CEA was 81.3%,the specificity was 91.7%,the accuracy was 85.7%,the PPVs was 92.9%,the NPVs was 78.6%,the sensitivity of the combined PET/CT and CA19-9 was 75.0%,the specificity was 91.7%,the accuracy was 82.1%,PPVs was 92.3%,NPVs was 73.3%.Which combined PET/CT with CEA and CA19-9,the sensitivity,specificity,accuracy,PPVs and NPvs were 68.8%,91.7%,78.6%,84.6% and 68.8%,respectively.We set the positive when one of the result was positive,and in this way,we got the sensitivity of 100%,specificity of 75.0%,accuracy of 89.3%,PPVs of 84.2%,NPVs of 100%.The AUC that SUVmax monitoring of postoperative recurrence of colorectal cancer was 0.919,95%CI:(0.797-1.042),and the optimal SUVmax cut-off was 3.6(sensitivity of 87.5%,specificity of 91.7%).The AUC for CEA ROC curve monitoring of postoperative recurrence of colorectal cancer was 0.938,95%CI :(0.845-1.032),the optimal CEA cut-off was 4.38 ng/ml(sensitivity of 100%,specificity of 83.3%),The AUC for CA19-9 ROC curve was 0.872,95%CI:(0.719-1.026).The optimal CA19-9 cut-off is 39.2 U/ml(sensitivity of 83.3%,specificity of 100%).Conclusion: 18F-FDG PET/CT has highly application value in monitoring postoperative recurrence in colorectal cancer.CEA and CA19-9 have good complementary and supplementary effects on PET/CT.The recurrence rate in colorectal cancer would be greater when SUVmax ≥3.6,CEA ≥4.38 ng/ml,and CA19-9 ≥39.2 U/ml.Part two The correlation between 18F-FDG PET/CT imaging SUVmax and tumor markers CEA and CA19-9 in colorectal cancerObjective: Colorectal cancer is the most common malignancy in gastrointestinal tract.Its early symptoms and manifestations are not obvious.Most patients were at the advanced stage when they were diagnosed.Early detection,early diagnosis and early treatment are important for improvement of quality of life and prognosis of patients with colorectal cancer.18F-FDG PET/CT and tumor markers examination is a commonly used examination method.At present,there were many studies on the value of 18F-FDG PET/CT examination in colorectal cancer.The correlation between tumor markers CEA and CA19-9 in prognosis of colorectal cancer is also common.Few studies on the correlation between SUVmax of 18F-FDG PET/CT in colorectal cancer and serum CEA and CA19-9.Therefore,take a retrospective analysis of 43 cases of colorectal cancer in Affiliated Hospital of Chuanbei Medical College,the correlation between 18F-FDG PET/CT imaging SUVmax and serum CEA and CA19-9 was investigated in colorectal cancerMethods: A total of 43 cases of colorectal cancer were collected from Affiliated Hospital of Chuanbei Medical College from december 2015 to december 2017,and related pathological data were collected,such as SUVmax,CEA,CA19-9,sex,age,primary site and so on.The correlation between the pathological features and serum CEA,CA19-9 and SUVmax in patients with colorectal cancer before and after operation was analyzed,respectively.The correlation between serum CEA,CA19-9 and SUVmax before and after operation was analyzed respectively,too.The value of SUVmax to evaluate the increase of CEA and CA19-9 was evaluated through the ROC curve.All data were analyzed by SPSS13.0,P < 0.05,the difference was statistically significant.Results: Before radical resection of colorectal cancer: there was no correlation between SUVmax and the sex,age,primary site,lymph node metastasis and distant metastasis(P > 0.05).Serum CEA was associated with the primary site and lymph node metastasis before operation(P < 0.05),there was no correlation with sex,age,distant metastasis(P > 0.05).There was no correlation between serum CA19-9 and sex,age,primary site,lymph node metastasis and distant metastasis(P > 0.05).After radical resection of colorectal cancer : there was a correlation between SUVmax,CEA,CA19-9 and lymph node metastasis(P < 0.05),and no correlation with sex,age,primary site and distant metastasis(P > 0.05).According to SUVmax,the AUC of CEA increased ROC curve was 0.818,and its evaluation efficiency was intermediate,95% CI was(0.654-0.981).After calculation,the best cut-off value of SUVmax is 3.3(sensitivity 87.5%,specificity 75%).SUVmax evaluation of CA19-9 increased AUC was 0.793,95% CI was(0.612-0.974),SUVmax optimal cut-off value was 3.6(sensitivity 85.7%,specificity 78.6%).Conclusion: 1.The 18F-FDG PET/CT imaging SUVmax and serum tumor marker CA19-9 of preoperative colorectal cancer have no correlation with sex,age,primary site,lymph node and distant metastasis;the level of CEA is related to primary site and lymph node metastasis.Age,sex,and distant metastasis have not relation.2.For postoperative patients with colorectal cancer: 18F-FDG PET/CT imaging SUVmax,serum tumor markers CEA,CA19-9 were associated with lymph node metastasis,and were not related to sex,age,site of primary site and distant metastasis.3.There was no correlation between preoperative SUVmax and serum tumor markers CEA and CA19-9 in colorectal cancer patients.4.There was a correlation between postoperative SUVmax and serum tumor markers CEA and CA19-9 in patients with colorectal cancer,when SUVmax is greater than 3.3,CEA is more likely to rise,SUVmax is more than 3.6,and CA19-9 is more likely to rise. |
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