Glazer Evan S, Beaty Karen, Abdalla Eddie K, Vauthey J Nicolas, Curley Steven A
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.
Arch Surg. 2010 Apr;145(4):340-5; discussion 345. doi: 10.1001/archsurg.2010.41.
Chemotherapeutic agents may be able to convert unresectable colorectal hepatic metastasis to resectable disease, therefore changing the surgical options. The role of positron emission tomography (PET) for patients undergoing chemotherapy remains unclear. We hypothesize that recent chemotherapy treatment could result in false-negative PET results.
Case-control study evaluating PET findings.
The University of Texas M. D. Anderson Cancer Center.
From May 1, 2006, through August 31, 2008, data for 224 consecutive patients were entered into a prospective database for evaluation of hepatic metastasis of colorectal carcinoma. One hundred thirty-eight patients underwent PET and conventional imaging (a combination of computed tomography, magnetic resonance imaging, and ultrasonography). All had oncologically sound colorectal operations.
Liver resection or ablation for colorectal liver metastases.
To determine the accuracy of PET scans to detect residual viable colorectal cancer liver metastases after a significant response to systemic chemotherapy.
Patients with biopsy-proven disease underwent hepatic resection (120 patients [87.0%]), radiofrequency ablation (2 [1.4%]), or resection with radiofrequency ablation (7 [5.1%]). Nine patients (6.5%) had inoperable disease that was found intraoperatively. When performed within 4 weeks of chemotherapy, PET had a negative predictive value of 13.3% and a positive predictive value of 94.3%. The sensitivity was 89.9%, the specificity was 22.2%, and the accuracy was 85.5%.
Positron emission tomography within 4 weeks of chemotherapy is not a useful test for evaluation of colorectal hepatic metastases. The high rate of false-negative results is likely due to metabolic inhibition caused by chemotherapeutic drugs. We recommend that physicians not use PET in patients recently completing chemotherapy; they should undergo the appropriate oncologic hepatic operation based on the high probability of viable malignant disease.
化疗药物或许能够将无法切除的结直肠癌肝转移转化为可切除疾病，从而改变手术选择。正电子发射断层扫描（PET）在接受化疗患者中的作用仍不明确。我们推测近期的化疗可能导致PET结果出现假阴性。
评估PET检查结果的病例对照研究。
德克萨斯大学MD安德森癌症中心。
从2006年5月1日至2008年8月31日，连续224例患者的数据被录入前瞻性数据库，以评估结直肠癌肝转移情况。138例患者接受了PET及传统影像学检查（计算机断层扫描、磁共振成像和超声检查相结合）。所有患者均接受了肿瘤学上合理的结直肠手术。
对结直肠癌肝转移进行肝切除或消融。
确定PET扫描检测在对全身化疗有显著反应后残留的可存活结直肠癌肝转移灶的准确性。
经活检证实患有疾病的患者接受了肝切除（120例患者[87.0%]）、射频消融（2例[1.4%]）或联合射频消融的切除（7例[5.1%]）。9例患者（6.5%）术中发现有无法手术的疾病。在化疗后4周内进行PET检查时，其阴性预测值为13.3%，阳性预测值为94.3%。敏感性为89.9%，特异性为22.2%，准确性为85.5%。
化疗后4周内进行的正电子发射断层扫描对评估结直肠癌肝转移并无帮助。假阴性结果的高发生率可能是由于化疗药物引起的代谢抑制。我们建议医生不要对近期完成化疗的患者使用PET检查；应根据存在可存活恶性疾病的高可能性，对他们进行适当的肿瘤学肝脏手术。
