The Standardized Uptake Value (SUV) Of 18F-fluorodeoxyglucose (FDG) Uptake And Its Correlation With The Traditional Chinese Medical (TCM) Of Syndrome, Clinical Stages And The Expression Of Ki67, Et Al, In 32 Case Of Nasopharyngeal Carcinoma (NPC)

Objective:To investigate the SUV of 18F-FDG uptake and its mutual correlation with the TCM of syndrome,the clinical stages and the expression of Ki67,VEGF,EGFR,survivin, Bcl-2,nm23-H1 in NPC.Methods:Whole body ¹⁸F-FDG-PET imaging was performed in 32 patients with NPC,who was based on the biopsy data and no previous treatment,the regions of interest(ROI) including both the pharyngeal and cervical lesion were draw along the sizes of lesion, which were calculated by the formula:L＝(length of long axis+short axis+longitudinal axis)/3.The expression of Ki67,EGFR,VEGF,Survivin,Bcl-2,nm23-H1 in NPC tissue was immunohistochemically assessed.Results:(1) The SUV of primary lesion inâ… ,â…¡,â…¢,â…£staging were 4.50±0.42,5.62±1.44,7.33±1.50,8.24±2.16,respectively.There was no significant difference between them(P＜0.05).The SUV in T1,T2,T3,T4 staging were 2.56±1.05,3.72±0.60,6.87±1.07,9.70±0.70,respectively,The difference was statistically significant(P＜0.05).The SUV in N1,N2,N3 staging were no significant difference,but the difference was statistically significant(P＜0.05) when the maxium diameter of the lymph node metastases bigger or less than 6cm.The SUV in poorly differentiated squamous carcinoma was smaller than that of undifferentiated carcinoma(5.58±1.48 vs.8.41±1.71,F＝1.3323, P＝0.01).The difference was statistically significant(P＜0.01).(2) The positive expression rates of Ki67,VEGF,EGFR,Survivin,Bcl-2 and nm23-HI in 32 cases of NPC was 84.4%(27/32),84.4%(27/32),78.1%(25/32),68.7%(22/32), 71.9%(23/32),62.5%(20/32),respectively.The positive expression rates of Ki67,VEGF, EGFR,Survivin and Bcl-2 in the advanced stage(â…¢,â…£) was higher than the early stage (â… ,â…¡) with obviously statistically significant difference(P＜0.05),respectively.The positive expression rates of nm23-H1 in the advanced stage NPC(â…¢,â…£) was lower than the early stage(â… ,â…¡) with obviously statistically significant difference(P＜0.05).The positive expression rates of Survivin,Bcl-2,nm23-H1,Ki67,VEGF and EGFR in undifferentiated carcinoma was higher than the poorly differentiated squamous cell carcinoma with obviously statistically significant difference(P＜0.05) in Survivin,Bcl-2 and with no statistically significant difference(P＞0.05) in nm23-H1,Ki67,VEGF and EGFR,respectively.The expression rates of Survivin,Bcl-2,Ki67,VEGF,EGFR in the patient with neck lymph node metastases was higher than the patient with no lymph node metastases.The difference wasn't statistically significant(P＞0.05) in Survivin,Bcl-2 and was obviously statistically significant difference(P＜0.05) in Ki67,VEGF and EGFR.On the contrary,the positive expression rates of nm23-H1 in the patients with the neck lymph node metastases were lower than the no lymph node metastases with obviously statistically significant difference(P＜0.05).(3) Positive rate of Ki67 expression in NPC was 0～70%.The SUV was correlated with the Ki67 expression significantly(r＝0.591,P＜0.01).The SUV had an increasing tendency from low to high of Ki67 positive express,as Ki67 expression over than 20%was defined as high expression and lower than 20%was low expression.The SUV in high,lower and negative expression of ki67 were 8.95±0.78,7.71±1.59 and 4.90±0.78,respectively.There were significant differences among the high,lower and negative expression(P＜0.01), respectively,except the high and lower expression(P＞0.05).The mean SUV in the patient of positive expression of VEGF,Survivin and Bcl-2 was-higher than the negative one with no statistically significant difference(P＞0.05).The mean SUV of the patients with positive and weak-positive expression of EGFR were higher than the negative one with statistically significant difference(P＜0.01)which the weakly positive(+) and positive(++) expression rate of EGFR were 31.3%(10/32) and 46.8%(15/32),respectively.The mean SUV in the patients of positive expression of nm23-H1 was lower than the negative one with obviously significant difference(P＜0.01).(4) There was mainly the type of lung-heat and sputum-coagulate of the TCM in the stage ofâ… andâ…¡of NPC,which the type of lung-heat and sputum-coagulate were 42.9%and 40 %in the stageâ… and 57.1%and 60%in the stageâ…¡,respectively.There was mainly the type of obstruction of collaterals by blood stasis and blood stasis with sputum-coagulate in the stage ofâ…¢andâ…£,which the type of obstruction of collaterals by blood stasis and blood stasis with sputum-coagulate were 66.7%and 40%in the stageâ…¢and 33.3% and 60%in the stage ofâ…£respectively.The TCM of syndrome with the type of lung-heat,sputum-coagulate,obstruction of collaterals by blood stasis and blood stasis with sputum-coagulate with neck lymphatic metastases were 14.3%,100%,100%and 100%, respectively.There were no significant difference of TCM of syndrome between the poorly differentiated and the undifferentiated carcinoma.Conclusion:(1) The SUV is correlated to T stage and the size of lymph node metastases which the maxium diameter is bigger or less than 6 cm,although the SUV has a no relationship with the clinical staging and N staging of NPC.(2) The SUV is correlated to the Pathology of NPC tissue.(3) There was high expression of Ki67,VEGF,EGFR and survivin,Bcl-2,nm23-H1 in NPC tissue.Ki67,VEGF,EGFR,survivin,Bcl-2 and nm23-H1 were related to the clinical stage of NPC.The expression of Ki67,VEGF,EGFR and nm23-H1 have a correlation with the neck lymph node metastases and a no correlation with the cell differentiation,On the contrary,the expression of Survivin and Bcl-2 have a correlation with the differentiation and a no correlation with the neck lymph node.(4) The SUV in NPC primary lesion is correlated with Ki67,EGFR and nm23-H1 expression.The SUV had a increasing tendency from low to high of Ki67 positive express and may be useful for clinical prediction of tumor proliferate capacity.There is no correlation between SUV and VEGF,Survivin and Bcl-2 expression.(5) The TCM of syndrome is correlated to the clinical staging possibly,except the cell differentiations of NPC tissue.