SUV2值與形態(tài)學緩解率及進行R0切除術可能性的關系
在完成初步的新輔助放化療(CRT)后，通過非侵入式的評價手段對腫瘤緩解率進行判斷有助于治療決策的形成,，從而篩選出可從手術治療中獲益的患者,。而對于氟標記-氟脫氧葡萄糖正電子發(fā)射斷層掃描(FDG-PET)能否提供相關臨床的信息，目前仍存在爭議,。為此，法國里爾大學醫(yī)院的Christophe Mariette博士等人進行了一項研究(研究登記信息：http://www.e-cancer RECF0350.)，該研究針對可切除的局部晚期食管癌患者,，對患者完成新輔助放化療(CRT)后，F(xiàn)DG-PET在腫瘤緩解率方面的評價作用進行了考察。這項研究結(jié)果發(fā)表于2013年3月6日在線出版的《外科學年鑒》(Annals of Surgery)雜志上,。
這項前瞻性研究的招募對象為可進行手術治療的局部晚期食管癌患者(臨床分期為 T3 N0-1 M0),。完整的治療方案包括新輔助CRT(順鉑 + 5-氟尿嘧啶/45 Gy)，6-8周后進行全胸段食管切除術治療,。在CRT開始前2周以及CRT結(jié)束4-6周時,，通過形態(tài)學及FDG-PET方法進行評價。研究人員對治療前及治療后的瘤內(nèi)FDG標準化攝取值(SUV1,、SUV2,、百分比變化量)進行了評價。并將這些變量與病理學緩解率,、形態(tài)緩解率和生存率進行了關聯(lián),。在研究者未發(fā)現(xiàn)出現(xiàn)病情轉(zhuǎn)移時，在FDG-PET結(jié)果方面采用研究者盲法,。
在60例患者中,，有46例患者完成了全部治療方案治療(患者中位年齡: 60.1 歲; 腺癌: 25 例; 鱗狀細胞癌: 21例)。研究人員發(fā)現(xiàn),，45.7%的患者得到了較大程度的病理緩解,，且結(jié)局良好(P = 0.057)。新輔助CRT顯著降低了瘤內(nèi)FDG攝取值(P < 0.001),。病理緩解(完全或較大程度緩解)及FDG-PET結(jié)果之間并未顯著關聯(lián)(P > 0.280),。SUV2值與形態(tài)學緩解率及進行R0切除術可能性之間存在關聯(lián)(P < 0.018; 受試者操作特性曲線分析: SUV2 閾值 = 5.5)。本研究未發(fā)現(xiàn)代謝成像與復發(fā)率及生存率之間存在顯著關聯(lián),。
研究人員最終認為,，對于接受新輔助CRT繼以手術治療的局部晚期食管癌患者，F(xiàn)DG-PET與其病理緩解率及長期生存率之間并無有效聯(lián)系,。（生物谷Bioon.com）
DOI: 10.1097/SLA.0b013e31828676c4
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Ineffectiveness of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Evaluation of Tumor Response After Completion of Neoadjuvant Chemoradiation in Esophageal Cancer
Piessen G Petyt G Duhamel A Mirabel X Huglo D Mariette C
OBJECTIVE:: To evaluate the role of F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the assessment of tumor response after the completion of neoadjuvant chemoradiation (CRT) in patients with locally advanced resectable esophageal cancer. BACKGROUND:: After primary CRT, a noninvasive evaluation of the tumor response could help in the treatment decision to identify patients who may benefit from surgery. Whether FDG-PET provides clinically relevant information remains questionable. METHODS:: Operable patients with locally advanced esophageal cancer (clinically staged T3 N0-1 M0) were enrolled in this prospective study. The complete treatment plan included neoadjuvant CRT (cisplatin + 5-fluorouracil/45 Gy) followed 6 to 8 weeks later by a transthoracic en bloc esophagectomy. Morphological evaluation combined with FDG-PET was performed 2 weeks before the start of CRT and 4 to 6 weeks after the completion of CRT. Intratumoral pre- and posttreatment FDG-standardized uptake values (SUV1, SUV2, percentage change) were assessed. These variables were correlated with pathological and morphologic responses and survival. Investigators were blinded to the FDG-PET results unless they revealed metastatic disease. RESULTS:: Of 60 total patients, 46 underwent the complete treatment plan (median age: 60.1 years; adenocarcinoma: 25 patients; squamous cell cancer: 21 patients). A major pathological response occurred in 45.7% of patients and was associated with a favorable outcome (P = 0.057). Neoadjuvant CRT led to a significant reduction in intratumoral FDG-uptake (P < 0.001). No significant association was seen between a pathological response (either complete or major) and the FDG-PET results (P > 0.280). The SUV2 value was correlated with a morphological response and the possibility to perform an R0 resection (P < 0.018; receiver operating characteristic curve analysis: SUV2 threshold = 5.5). No significant association was found between metabolic imaging and recurrence or survival. CONCLUSIONS:: FDG-PET does not effectively correlate with pathological response and long-term survival in patients with locally advanced esophageal cancer undergoing neoadjuvant CRT followed by surgery.
