连续检测血清 Ca15.3 能否提高 PET/CT 的诊断准确性？：来自既往乳腺癌小人群的结果。

Could the serial determination of Ca15.3 serum improve the diagnostic accuracy of PET/CT?: results from small population with previous breast cancer.

机构信息

Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto (IOV), IRCCS, Padua, Italy.

出版信息

Ann Nucl Med. 2011 Aug;25(7):469-77. doi: 10.1007/s12149-011-0488-9. Epub 2011 Apr 8.

DOI:10.1007/s12149-011-0488-9

PMID:21476056

Abstract

OBJECTIVES

A single value of tumor marker elevation is not used for the diagnosis of breast cancer (BC) relapse, whereas the serial measurements which confirm a persistent Ca15.3 increase can represent an early signal of tumor relapse, even if described in asymptomatic patients without any other clinical or instrumental signs of cancer. The aim of this study was to assess the relationship between serial measures of Ca15.3 and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings in patients with already treated BC during follow-up.

METHODS

We retrospectively selected 60 patients (mean age 62 ± 11 years) with previous history of BC, already treated with surgery and other treatments. Three serial measures of Ca15.3 were collected within 1 year before PET/CT examination, respectively, at 12-9 months (297 ± 30 days), 9-3 months (154 ± 51 days) and 3-0 months (46 ± 28 days). Clinical outcome or imaging follow-up data were used to define disease relapse. The increase in tumor marker value was compared with PET/CT results and disease relapse. Coefficient of variation (CV) and ROC curves were used. Disease-free survival (DFS) curves were computed by Kaplan-Meier method.

RESULTS

PET/CT was negative in 36 (60%) and positive in 24 (40%) patients. The median time between initial treatment and PET/CT was 3 years. CV of the Ca15.3 serial determinations was significantly higher in patients with positive than negative PET/CT (39 vs. 24%, p < 0.05). Disease relapse was found in 25 (42%) patients, of these 21 (88%) had positive PET/CT. ROC analyses showed that an increase of Ca15.3 between the 2nd and 3rd measures have better individuated positive PET/CT and disease relapse (AUC 0.65 and 0.64, respectively; p < 0.05). DFS was higher in patients with negative than positive PET/CT (65 vs. 15%, p < 0.05).

CONCLUSIONS

Serial increase of Ca15.3 could be considered optimal to address FDG PET/CT examination during BC patients follow-up. PET/CT performed just on time might allow, earlier and with higher diagnostic accuracy, the detection of disease relapse in BC patients.

摘要

目的

肿瘤标志物升高的单一数值不用于诊断乳腺癌（BC）复发，而连续测量值可证实 CA15.3 持续升高，这可能代表肿瘤复发的早期信号，即使在无症状患者中也是如此，这些患者没有任何其他癌症的临床或仪器迹象。本研究旨在评估已接受治疗的 BC 患者在随访期间 CA15.3 连续测量值与 18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）结果之间的关系。

方法

我们回顾性选择了 60 名（平均年龄 62±11 岁）既往有 BC 病史的患者，这些患者已经接受了手术和其他治疗。在 PET/CT 检查前的 1 年内分别采集了 3 次 CA15.3 连续测量值，分别为 12-9 个月（297±30 天）、9-3 个月（154±51 天）和 3-0 个月（46±28 天）。临床结果或影像学随访数据用于定义疾病复发。将肿瘤标志物值的升高与 PET/CT 结果和疾病复发进行比较。使用变异系数（CV）和 ROC 曲线。通过 Kaplan-Meier 方法计算无病生存率（DFS）曲线。

结果

PET/CT 阴性的患者为 36 例（60%），阳性的患者为 24 例（40%）。初始治疗与 PET/CT 之间的中位时间为 3 年。CA15.3 连续测定的 CV 在 PET/CT 阳性患者中明显高于阴性患者（39%比 24%，p<0.05）。25 名（42%）患者发现疾病复发，其中 21 名（88%）患者 PET/CT 阳性。ROC 分析显示，第 2 次和第 3 次 CA15.3 测量值之间的升高更好地识别了阳性 PET/CT 和疾病复发（AUC 分别为 0.65 和 0.64，p<0.05）。PET/CT 阴性患者的 DFS 高于阳性患者（65%比 15%，p<0.05）。