Department of Clinical Surgery, Trinity Centre for Health Science, Trinity College Dublin, St James's Hospital, Dublin, Ireland.
J Nucl Med. 2010 Dec;51(12):1863-9. doi: 10.2967/jnumed.110.079566. Epub 2010 Nov 15.
This study evaluated the role of (18)F-FDG PET as an early predictor of histopathologic response to neoadjuvant chemoradiotherapy and overall survival in patients with adenocarcinoma of the esophagus undergoing multimodal therapy.
Thirty-seven patients with locally advanced adenocarcinoma of the esophagus underwent pretreatment and an intratreatment (18)F-FDG PET scan in the second week of a 6-wk regimen of neoadjuvant chemoradiotherapy. Histopathologic response and overall survival were correlated with percentage change in (18)F-FDG uptake (%Δmaximum standardized uptake value [%ΔSUVmax]).
In 16 patients (43%), treatment induced a histopathologic response (<10% viable tumor cells), which was associated with a significant (P < 0.05) survival benefit. The optimal reduction in (18)F-FDG uptake, which separated histopathologic responders and nonresponders, was a -26.4% ΔSUVmax (receiver-operating-characteristic curve analysis). At this separation, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (area under the receiver operating characteristic curve) were 62.5%, 71.4%, 62.5%, 71.4%, and 67.4%, respectively, for intratreatment (18)F-FDG PET scans. Kaplan-Meier survival analysis of (18)F-FDG PET responders (>26.4% reduction in SUVmax), compared with (18)F-FDG PET nonresponders (<26.4% reduction in SUVmax), revealed no survival benefit for responders (P = 0.6812).
The %ΔSUVmax during the second week of induction chemoradiation did not correlate either with histopathologic response or with survival. Our results show that, in contrast to published reports on neoadjuvant chemotherapy, combined chemoradiotherapy in patients with adenocarcinoma of the esophagus lowers the predictive accuracy of early repeated (18)F-FDG PET in identifying histopathologic responders and those with chances for increased survival below clinically applicable levels.
本研究旨在评估（18）F-FDG PET 作为预测接受新辅助放化疗的食管腺癌患者组织病理学反应和总生存率的早期指标的作用。
37 例局部晚期食管腺癌患者在新辅助放化疗 6 周方案的第 2 周接受了预处理和治疗期间（18）F-FDG PET 扫描。组织病理学反应和总生存率与（18）F-FDG 摄取百分比变化（%Δ最大标准化摄取值 [%ΔSUVmax]）相关。
在 16 例患者（43%）中，治疗诱导了组织病理学反应（<10%存活肿瘤细胞），这与显著的生存获益相关（P < 0.05）。区分组织病理学反应者和无反应者的最佳（18）F-FDG 摄取减少量为-26.4%ΔSUVmax（受试者工作特征曲线分析）。在此分界处，治疗期间（18）F-FDG PET 扫描的敏感性、特异性、阳性预测值、阴性预测值和准确性（受试者工作特征曲线下面积）分别为 62.5%、71.4%、62.5%、71.4%和 67.4%。与（18）F-FDG PET 无反应者（SUVmax 减少<26.4%）相比，（18）F-FDG PET 反应者（SUVmax 减少>26.4%）的 Kaplan-Meier 生存分析未显示出反应者的生存获益（P=0.6812）。
诱导放化疗第 2 周的%ΔSUVmax 与组织病理学反应或生存率均无相关性。我们的结果表明，与新辅助化疗的已发表报告相反，食管腺癌患者的联合放化疗降低了早期重复（18）F-FDG PET 识别组织病理学反应者和生存机会增加者的预测准确性，降至临床适用水平以下。
