Vallböhmer D, Hölscher A H, Schneider P M, Schmidt M, Dietlein M, Bollschweiler E, Baldus S, Alakus H, Brabender J, Metzger R, Mönig S P
Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
J Surg Oncol. 2010 Aug 1;102(2):135-40. doi: 10.1002/jso.21592.
Neoadjuvant chemotherapy is applied to improve the prognosis of patients with advanced gastric cancer. However, only a major histopathological response will provide a benefit. Recent studies suggest that [(18)F]-fluorodeoxyglucose-positron-emission-tomography (FDG-PET) correlates with response and survival in patients with gastroesophageal adenocarcinomas undergoing neoadjuvant chemotherapy. We evaluated the potential of FDG-PET for the assessment of response and prognosis in the multimodality treatment of gastric cancer.
Study patients were recruited from a prospective observation trial. Forty two patients with advanced gastric cancer received neoadjuvant chemotherapy and subsequently 40 patients underwent standardized gastrectomy (2 patients with tumor progression had therapy limited to palliative chemotherapy without surgery). Histomorphologic regression was defined as major response when resected specimens contained <10% vital tumor cells. FDG-PET was performed before and 2 weeks after the end of neoadjuvant chemotherapy with assessment of the intratumoral FDG-uptake [pre-treatment standardized uptake value (SUV1); post-treatment SUV (SUV2); percentage change (SUVDelta%)].
Histomorphological tumor regression was confirmed as a prognostic factor (P = 0.039). No significant correlations between SUV1, SUV2, or SUVDelta% and response or prognosis were found.
FDG-PET seems not to be an imaging system that effectively characterizes major/minor response and survival in patients with gastric cancer following multimodality treatment.
新辅助化疗用于改善晚期胃癌患者的预后。然而，只有主要组织病理学反应才会带来益处。近期研究表明，[18F]氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）与接受新辅助化疗的胃食管腺癌患者的反应及生存情况相关。我们评估了FDG-PET在评估胃癌多模式治疗中的反应及预后方面的潜力。
研究患者来自一项前瞻性观察试验。42例晚期胃癌患者接受新辅助化疗，随后40例患者接受标准化胃切除术（2例肿瘤进展患者的治疗限于姑息化疗，未进行手术）。当切除标本中存活肿瘤细胞<10%时，组织形态学退缩被定义为主要反应。在新辅助化疗结束前及结束后2周进行FDG-PET检查，评估肿瘤内FDG摄取情况[治疗前标准化摄取值（SUV1）；治疗后SUV（SUV2）；变化百分比（SUVDelta%）]。
组织形态学肿瘤退缩被确认为一个预后因素（P = 0.039）。未发现SUV1、SUV2或SUVDelta%与反应或预后之间存在显著相关性。
FDG-PET似乎不是一种能有效表征胃癌多模式治疗患者主要/次要反应及生存情况的成像系统。
