[正电子发射断层扫描对潜在可切除非小细胞肺癌临床管理的影响：一项法国前瞻性多中心研究]

[Impact of positron emission tomography on clinical management of potentially resectable non-small-cell lung cancer: a French prospective multicenter study].

作者信息

Margery J, Milleron B, Vaylet F, Grahek D, Lebeau B, Mangiapan G, Bonardel G, de Labriolle-Vaylet C, Meignan M, Carette M-F, Talbot J-N, Housset B

机构信息

Service des maladies respiratoires, hôpital d'instruction des armées Percy, Clamart, France.

出版信息

Rev Pneumol Clin. 2010 Oct;66(5):313-20. doi: 10.1016/j.pneumo.2010.07.015. Epub 2010 Sep 15.

DOI:10.1016/j.pneumo.2010.07.015

PMID:21087727

Abstract

BACKGROUND

Whole-body (18)F-deoxyglucose positron emission tomography (FDG-PET) has the potential to improve the management of non-small-cell lung cancer (NSCLC). We prospectively evaluated the impact of combining FDG-PET with conventional staging methods, including computed tomography (CT), on the staging and management of patients with potentially resectable NSCLC.

METHODS

Ninety-four consecutive patients with newly diagnosed/suspected NSCLC were enrolled. Each patient was first staged by using conventional methods, and then by FDG-PET. FDG-PET results were forwarded in a sealed envelope and divulged at the weekly staff meeting on staging and treatment, only after "Decision 1", based on conventional staging, had been reached by consensus; reevaluation taking FDG-PET into account yielded "Decision 2". The validity of these latter decisions was analyzed retrospectively.

RESULTS

Eighty-nine patients were eligible. Relative to standard imaging, FDG-PET led to clinical staging changes in 26 (29.2%) patients. The stage was lowered in eight cases (9%) and raised in 18 cases (20.2%). "Decision 2" differed from "Decision 1" in 19 patients, modifying the surgical procedure in four cases, indicating other investigations to confirm FDG-PET evidence of metastases in 12 cases, or modifying the medical treatment in three cases. These modifications were retrospectively justified in 9/19 cases, and consisted of 2/4 modifications of the surgical procedure (one hilar and one adrenal metastasis not confirmed histologically), 4/12 further investigations (axillary and liver biopsies, mediastinoscopy, occult colon cancer) and three indications for palliative treatment, in patients who all died within 3 months after FDG-PET.

CONCLUSIONS

Based on FDG-PET, management was modified in 19/89 (21.3%) patients, but these changes were justified in only 9/89 patients (10.1%). FDG-PET can detect asymptomatic local and distant metastases and improves the preoperative assessment of NSCLC, thereby avoiding unnecessary surgery. However, histological verification is required because of the risk of false-positive results.

摘要

背景

全身（18）F - 脱氧葡萄糖正电子发射断层扫描（FDG - PET）有潜力改善非小细胞肺癌（NSCLC）的治疗管理。我们前瞻性评估了将FDG - PET与包括计算机断层扫描（CT）在内的传统分期方法相结合，对潜在可切除NSCLC患者分期及治疗管理的影响。

方法

连续纳入94例新诊断/疑似NSCLC患者。每位患者首先采用传统方法进行分期，然后进行FDG - PET检查。FDG - PET结果装于密封信封中传递，并仅在基于传统分期达成“决策1”共识后，于每周的分期及治疗员工会议上公布；考虑FDG - PET结果后的重新评估得出“决策2”。对这些后续决策的有效性进行回顾性分析。

结果

89例患者符合条件。相对于标准影像学检查，FDG - PET使26例（29.2%）患者的临床分期发生改变。其中8例（9%）分期降低，18例（20.2%）分期升高。“决策2”与“决策1”在19例患者中不同，4例改变了手术方式，12例表明需进行其他检查以证实FDG - PET提示的转移灶，3例改变了药物治疗。这些改变在9/19例中经回顾性分析证明合理，包括2/4例手术方式改变（1例肺门和1例肾上腺转移灶经组织学检查未证实），4/12例进一步检查（腋窝和肝脏活检、纵隔镜检查、隐匿性结肠癌）以及3例姑息治疗指征，这些患者在FDG - PET检查后3个月内均死亡。