LaTIM, INSERM U650, CHU Morvan, 5 avenue Foch, 29609 Brest, France.
Eur J Nucl Med Mol Imaging. 2011 Sep;38(9):1595-606. doi: 10.1007/s00259-011-1834-9. Epub 2011 May 11.
The objectives of this study were to investigate the predictive value of tumour measurements on 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) positron emission tomography (PET) pretreatment scan regarding therapy response in oesophageal cancer and to evaluate the impact of tumour delineation strategies.
Fifty patients with oesophageal cancer treated with concomitant radiochemotherapy between 2004 and 2008 were retrospectively considered and classified as complete, partial or non-responders (including stable and progressive disease) according to Response Evaluation Criteria in Solid Tumors (RECIST). The classification of partial and complete responders was confirmed by biopsy. Tumours were delineated on the (18)F-FDG pretreatment scan using an adaptive threshold and the automatic fuzzy locally adaptive Bayesian (FLAB) methodologies. Several parameters were then extracted: maximum and peak standardized uptake value (SUV), tumour longitudinal length (TL) and volume (TV), SUV(mean), and total lesion glycolysis (TLG = TV × SUV(mean)). The correlation between each parameter and response was investigated using Kruskal-Wallis tests, and receiver-operating characteristic methodology was used to assess performance of the parameters to differentiate patients.
Whereas commonly used parameters such as SUV measurements were not significant predictive factors of the response, parameters related to tumour functional spatial extent (TL, TV, TLG) allowed significant differentiation of all three groups of patients, independently of the delineation strategy, and could identify complete and non-responders with sensitivity above 75% and specificity above 85%. A systematic although not statistically significant trend was observed regarding the hierarchy of the delineation methodologies and the parameters considered, with slightly higher predictive value obtained with FLAB over adaptive thresholding, and TLG over TV and TL.
TLG is a promising predictive factor of concomitant radiochemotherapy response with statistically higher predictive value than SUV measurements in advanced oesophageal cancer.
本研究旨在探讨氟代脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）预处理扫描中肿瘤测量值对食管癌治疗反应的预测价值，并评估肿瘤勾画策略的影响。
回顾性分析了 2004 年至 2008 年间接受同期放化疗的 50 例食管癌患者，根据实体瘤反应评价标准（RECIST）将其分为完全、部分或无反应者（包括稳定和进展性疾病）。部分和完全缓解者的分类通过活检确认。在 18F-FDG 预处理扫描上使用自适应阈值和自动模糊局部自适应贝叶斯（FLAB）方法进行肿瘤勾画。然后提取以下参数：最大标准化摄取值（SUV）和峰值 SUV（SUVpeak）、肿瘤纵向长度（TL）和体积（TV）、SUV 平均值（SUVmean）和总病变糖酵解（TLG = TV × SUVmean）。使用 Kruskal-Wallis 检验研究各参数与反应之间的相关性，并使用受试者工作特征（ROC）曲线分析参数对患者进行区分的性能。
尽管 SUV 等常用参数不是反应的显著预测因素，但与肿瘤功能空间范围相关的参数（TL、TV、TLG）可独立于勾画策略对所有三组患者进行显著区分，其对完全和无反应者的识别敏感性均高于 75%，特异性均高于 85%。虽然没有统计学意义，但观察到勾画方法和考虑的参数的分层存在系统趋势，FLAB 略优于自适应阈值，TLG 优于 TV 和 TL，具有更高的预测价值。
TLG 是一种很有前途的预测因素，可预测晚期食管癌同期放化疗的反应，其预测价值高于 SUV 测量值。
