Chang Ting-Chang, Law Kim-Seng, Hong Ji-Hong, Lai Chyong-Huey, Ng Koon-Kwan, Hsueh Suei, See Lai-Chu, Chang Yu-Chen, Tsai Chien-Sheng, Chou Hung-Hsueh, Huang Kuan-Gen, Liou Jui-Der, Lin Cheng-Tao, Chao Angel, Chen Min-Yu, Wu Tzu-I, Ma Shih-Ya, Yen Tzu-Chen
Department of Obstetrics and Gynecology, Linkou Medical Center/Chang Gung Medical College, Chang Gung Memorial Hospital, 5 Fu0Shin Road, Kueishan, Taoyuan 333, Taiwan.
Cancer. 2004 Jul 1;101(1):164-71. doi: 10.1002/cncr.20349.
During follow-up for patients with cervical carcinoma, elevation of serum squamous cell carcinoma antigen (SCC-Ag) levels in the absence of detectable recurrent lesions presents a diagnostic and therapeutic challenge. In the current prospective study, the authors evaluated the use of fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) to detect disease recurrence in this setting.
Women with cervical carcinoma who experienced complete responses to primary treatment or salvage therapy and who had no evidence of recurrent disease as detected by conventional methods but had serum SCC-Ag levels > or = 2.0 ng/mL on 2 consecutive occasions were eligible for the study. PET was performed within 2 weeks after the completion of conventional studies for the assessment of recurrence.
Twenty-seven consecutive patients were registered for the current study. PET findings were positive for 19 patients: 14 who had a distant lesion or lesions, 2 who had a local lesion or lesions, and 3 who had both local and distant lesions. Of these 19 patients, 17 were confirmed to have recurrent disease; the remaining two were found to be free of disease but had severe anthracosis in the PET-positive mediastinal lymph nodes. Seven of the eight patients with negative PET findings were not found to have recurrent disease on follow-up. Overall, PET detected FDG-avid lesions in 17 (94%; P < 0.001) of the 18 patients with recurrent disease. Seven of these 18 patients received therapy with curative intent; complete control was achieved in 6, four of whom currently are alive and free of disease. The addition of PET in the current setting curbed the use of futile curative therapy and significantly increased overall survival for patients in the current cohort compared with a historical group of 30 consecutive patients who had elevated SCC-Ag levels as a first sign of recurrence.
PET expedited the detection of recurrent cervical carcinoma in patients with unexplained elevation of SCC-Ag levels. Such expedited detection may have positive effects on patient survival.
在宫颈癌患者的随访过程中，血清鳞状细胞癌抗原（SCC-Ag）水平升高而未发现可检测到的复发病变，这带来了诊断和治疗上的挑战。在当前这项前瞻性研究中，作者评估了使用氟-18标记的氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）来检测这种情况下的疾病复发情况。
宫颈癌患者在接受初始治疗或挽救性治疗后获得完全缓解，通过传统方法未检测到复发疾病证据，但连续两次血清SCC-Ag水平≥2.0 ng/mL的女性符合本研究条件。在完成用于评估复发的传统检查后2周内进行PET检查。
本研究连续登记了27例患者。PET检查结果显示19例患者呈阳性：14例有远处一处或多处病变，2例有局部一处或多处病变，3例既有局部病变又有远处病变。在这19例患者中，17例被确诊为疾病复发；其余2例虽未发现疾病，但PET阳性的纵隔淋巴结有严重炭末沉着症。PET检查结果为阴性的8例患者中，有7例在随访中未发现疾病复发。总体而言，PET在18例复发疾病患者中的17例（94%；P<0.001）检测到了FDG摄取性病变。这18例患者中有7例接受了根治性治疗；6例实现了完全控制，其中4例目前仍存活且无疾病。与一组连续30例以SCC-Ag水平升高作为复发首要迹象的历史患者相比，在当前情况下增加PET检查减少了无效根治性治疗的使用，并显著提高了当前队列患者的总生存率。
PET加快了SCC-Ag水平不明原因升高患者复发性宫颈癌的检测。这种加快检测可能对患者生存产生积极影响。
