Dalrymple-Hay M J R, Rome P D, Kennedy C, Fulham M, McCaughan B C
Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Eur J Cardiothorac Surg. 2002 Apr;21(4):611-4; discussion 614-5. doi: 10.1016/s1010-7940(02)00026-x.
Positron emission tomography (PET) scanning is more sensitive at detecting metastatic disease than conventional radiological techniques. For patients with pulmonary metastatic melanoma, we investigate if PET scanning to detect occult extra pulmonary disease prior to thoracotomy and metastectomy is associated with improved survival compared to patients staged by conventional radiology.
Between November 1984 and December 1999, 121 patients (90 males, 31 females) have undergone a thoracotomy and pulmonary metastectomy for metastatic melanoma. The age range was 19-84 years (mean 57, median 59). In every case all palpable nodules were removed and the diagnosis confirmed histologically. A total of 68 (56%) patients had a PET scan preoperatively, 53 (44%) underwent conventional or nuclear imaging. Patients with only radiologically isolated pulmonary disease are included.
Survival is 100% complete and totals 238 pt/years (mean 2.2 years, median 1.4 years). Survival (+/-SE) at 1, 3, 5 and 7 years for all patients is 68% (+/-4.5) (n=67), 36.6% (+/-5.2) (n=27), 22.1% (+/-4.8) (n=15) and 13.5% (+/-4.2) (n=7), respectively. Survival (+/-SE) was significantly better at 3 and 5 years in patients who underwent a PET scan preoperatively (Log rank P=0.002). There was no significant difference in survival by 7 years.
There is a significant survival benefit associated with excluding extra pulmonary disease using a PET scan prior to thoracotomy and metastectomy. We recommend that PET scanning be used in the investigation of patients with pulmonary metastatic melanoma prior to metastectomy.
正电子发射断层扫描（PET）在检测转移性疾病方面比传统放射技术更敏感。对于肺转移性黑色素瘤患者，我们研究与通过传统放射学分期的患者相比，在开胸手术和转移灶切除术之前进行PET扫描以检测隐匿性肺外疾病是否与生存率提高相关。
1984年11月至1999年12月期间，121例患者（90例男性，31例女性）因转移性黑色素瘤接受了开胸手术和肺转移灶切除术。年龄范围为19 - 84岁（平均57岁，中位数59岁）。在每种情况下，所有可触及的结节均被切除，并通过组织学确诊。共有68例（56%）患者术前进行了PET扫描，53例（44%）接受了传统或核成像检查。仅包括影像学上孤立性肺部疾病的患者。
生存情况完整，总计238人年（平均2.2年，中位数1.4年）。所有患者1、3、5和7年的生存率（±标准误）分别为68%（±4.5）（n = 67）、36.6%（±5.2）（n = 27）、22.1%（±4.8）（n = 15）和13.5%（±4.2）（n = 7）。术前进行PET扫描的患者在3年和5年时的生存率（±标准误）显著更高（对数秩检验P = 0.002）。7年时生存率无显著差异。
在开胸手术和转移灶切除术之前使用PET扫描排除肺外疾病与显著的生存获益相关。我们建议在转移灶切除术之前，对肺转移性黑色素瘤患者进行PET扫描检查。
