Seo Satoru, Hatano Etsuro, Higashi Tatsuya, Nakajima Akio, Nakamoto Yuji, Tada Masaharu, Tamaki Nobuyuki, Iwaisako Keiko, Mori Akira, Doi Ryuichiro, Ikai Iwao, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Surgery. 2008 Jun;143(6):769-77. doi: 10.1016/j.surg.2008.01.010. Epub 2008 Apr 11.
Patients with intrahepatic cholangiocarcinoma (ICC) have a poor prognosis, and lymph node metastasis is an important prognostic factor. In this study, we investigated the usefulness of fluorodeoxyglucose positron emission tomography (FDG-PET) as a marker for lymph node metastasis, P-glycoprotein (P-gp) expression, and recurrence in ICC.
The subjects were 35 patients who underwent FDG-PET. Detectability of lymph node metastasis using FDG-PET was compared with that using computed tomography (CT) or magnetic resonance imaging (MRI). In patients who underwent resection, expression of P-gp was examined immunohistochemically, and the relationship between P-gp expression and the standardized uptake value (SUV) in FDG-PET was investigated. Survival rates were analyzed using clinical and pathologic factors.
Of the 35 patients, 5 did not undergo surgery based on FDG-PET findings (2 with extrahepatic metastasis, and 3 with para-aortic lymph node metastasis) and 3 underwent laparotomy only (2 with peritoneal dissemination and 1 with para-aortic lymph node metastasis). The diagnostic accuracies of FDG-PET, CT, and MRI for detection of lymph node metastasis were 86%, 68%, and 57%, the sensitivities were 43%, 43% and 43%, and the specificities were 100%, 76%, and 64%, respectively. A negative correlation was found between SUV and P-gp expression (P = .002; r = -0.62). The disease-free survival rates in the high SUV group (>or=8.5) were significantly lower than in the low SUV group (<8.5; P = .04), and a high SUV was an independent predictor of postoperative recurrence in multivariate analysis (risk ratio, 1.3; P = .03).
FDG-PET is useful for prediction of lymph node metastasis, P-gp expression and recurrence in ICC.
肝内胆管癌（ICC）患者预后较差，淋巴结转移是一个重要的预后因素。在本研究中，我们调查了氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）作为ICC淋巴结转移、P-糖蛋白（P-gp）表达及复发标志物的有效性。
研究对象为35例行FDG-PET检查的患者。将FDG-PET检测淋巴结转移的能力与计算机断层扫描（CT）或磁共振成像（MRI）进行比较。对接受手术切除的患者，采用免疫组织化学方法检测P-gp表达，并研究P-gp表达与FDG-PET标准化摄取值（SUV）之间的关系。使用临床和病理因素分析生存率。
35例患者中，5例根据FDG-PET检查结果未接受手术（2例有肝外转移，3例有腹主动脉旁淋巴结转移），3例仅接受了剖腹手术（2例有腹膜播散，1例有腹主动脉旁淋巴结转移）。FDG-PET、CT和MRI检测淋巴结转移的诊断准确性分别为86%、68%和57%，敏感性分别为43%、43%和43%，特异性分别为100%、76%和64%。发现SUV与P-gp表达呈负相关（P = 0.002；r = -0.62）。高SUV组（≥8.5）的无病生存率显著低于低SUV组（<8.5；P = 0.04），在多因素分析中，高SUV是术后复发的独立预测因素（风险比，1.3；P = 0.03）。
FDG-PET有助于预测ICC的淋巴结转移、P-gp表达及复发。
