Graziosi Luigina, Bugiantella Walter, Cavazzoni Emanuele, Cantarella Francesco, Porcari Matteo, Baffa Nicodemo, Donini Annibale
Department of Surgery, General and Emergency Surgery, School of Medicine, University of Perugia, Santa Maria della Misericordia Hospital.
Ann Ital Chir. 2011 Mar-Apr;82(2):125-9.
Gastric cancer has a poor prognosis and a high rate of recurrences after surgery. The optimal method for assessing early recurrences is not defined: conventional imaging (ultrasonography, CT and MRI) have difficulty in detecting them, because they don't give information regarding metabolic features or tumor response to chemotherapy. Actually 18F-fluorodeoxyglucose positron emission (18FDG-PET) has several indications for the primary staging and the follow-up of colon-rectal, lung, breast, neck cancers and lymphoma, but its clinical role in gastric cancer is not assessed. Our study analyzes the role of 18FDG-PET integrated with CT scan in the detection of gastric cancer recurrence.
We retrospectively reviewed 50 patients which underwent follow-up 18FDG-PET/CT from 2006 to 2009 after radical surgery for gastric adenocarcinoma. Each study was repeated every 6 months for the first two years after surgery and every 12 months for the subsequent three years.
18FDG-PET/CT was positive for suspected neoplastic disease in 29 (58%) and negative in 21 (42%) patients, with 3 false positive and 3 false negative results. 18FDG-PET/CT showed highly effectiveness in early detection of recurrences, as observed in 17 patients that were totally asymptomatic, allowing the initiation of multimodal treatment resulting in an important increasing of survival.
18FDG-PET-CT has a very good sensitivity (89.7%) and specificity (85.7%) in detecting local and distant recurrences during post-operative follow-up. Positive 18FDG-PET/CT findings may lead to an early change in the management of these patients, directing them towards rescue surgery or chemotherapy thereby improving their overall survival
胃癌预后较差，术后复发率高。评估早期复发的最佳方法尚未明确：传统影像学检查（超声、CT和MRI）难以检测到复发，因为它们无法提供有关代谢特征或肿瘤对化疗反应的信息。实际上，18F-氟脱氧葡萄糖正电子发射断层扫描（18FDG-PET）在结直肠癌、肺癌、乳腺癌、颈部肿瘤和淋巴瘤的初始分期及随访中有多种应用指征，但其在胃癌中的临床作用尚未得到评估。我们的研究分析了18FDG-PET与CT扫描相结合在检测胃癌复发中的作用。
我们回顾性分析了50例在2006年至2009年间接受胃腺癌根治性手术后进行18FDG-PET/CT随访的患者。术后的前两年每6个月重复进行一次检查，随后三年每12个月重复一次。
18FDG-PET/CT检查中，29例（58%）患者的疑似肿瘤疾病呈阳性，21例（42%）呈阴性，有3例假阳性和3例假阴性结果。18FDG-PET/CT在早期复发检测中显示出高效性，17例完全无症状的患者被检测出复发，从而得以启动多模式治疗，显著提高了生存率。
18FDG-PET-CT在术后随访中检测局部和远处复发时具有非常高的敏感性（89.7%）和特异性（85.7%）。18FDG-PET/CT检查结果呈阳性可能会导致这些患者的治疗方案早期改变，引导他们接受挽救性手术或化疗，从而提高其总体生存率。
