放化疗后正电子发射断层扫描预测食管癌患者的病理反应和生存。
Postchemoradiotherapy positron emission tomography predicts pathologic response and survival in patients with esophageal cancer.
机构信息
Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):471-7. doi: 10.1016/j.ijrobp.2011.12.029. Epub 2012 Feb 28.
PURPOSE
To correlate the prechemoradiotherapy (CRT) and post-CRT metabolic tumor volume (MTV) on positron emission tomography (PET) scanning with the pathologic response and survival in patients receiving preoperative CRT for esophageal cancer.
MATERIALS AND METHODS
The medical records of 37 patients with histologically confirmed Stage I-IVA esophageal cancer treated with CRT with or without surgical resection were reviewed. Of the 37 patients, 21 received preoperative CRT (57%) and 16 received definitive CRT (43%). All patients had a pre-CRT and 32 had a post-CRT PET scan. The MTV was measured on the pre-CRT PET and post-CRT PET scan, respectively, using a minimum standardized uptake value (SUV) threshold x, where x = 2, 2.5, 3, or the SUV maximum × 50%. The total glycolytic activity (TGA(x)) was defined as the mean SUV × MTV(x). The MTV ratio was defined as the pre-CRT PET MTV/post-CRT MTV. The SUV ratio was defined similarly. A single pathologist scored the pathologic response using a tumor regression grade (TRG) scale.
RESULTS
The median follow-up was 1.5 years (range, 0.4-4.9). No significant correlation was found between any parameters on the pre-CRT PET scan and the TRG or overall survival (OS). Multiple post-CRT MTV values and post-TGA values correlated with the TRG and OS; however, the MTV(2.5(Post)) and TGA(2.5(Post)) had the greatest correlation. The MTV(2) ratio correlated with OS. The maximum SUV on either the pre-CRT and post-CRT PET scans or the maximum SUV ratio did not correlate with the TRG or OS. Patients treated preoperatively had survival similar compared with those treated definitively with a good PET response (p = 0.97) and significantly better than that of patients treated definitively with a poor PET response (p < 0.0001).
CONCLUSION
The maximum SUV was not a predictive or prognostic parameter. The MTV(2.5) and TGA(2.5) were useful markers for predicting the response and survival on the post-CRT PET scan. The MTV(2) ratio also correlated with survival. Post-CRT PET can potentially guide therapy after CRT.
目的
在接受术前放化疗（CRT）的食管癌患者中，比较正电子发射断层扫描（PET）扫描的 CRT 前和 CRT 后代谢肿瘤体积（MTV）与病理反应和生存的相关性。
材料和方法
回顾了 37 例经组织学证实的 I-IVA 期食管癌患者的病历，这些患者接受了 CRT 治疗，部分患者还接受了手术切除。其中 21 例患者（57%）接受了术前 CRT，16 例患者（43%）接受了根治性 CRT。所有患者均行 CRT 前 PET 扫描，32 例行 CRT 后 PET 扫描。在 CRT 前和 CRT 后 PET 扫描中，分别使用最小标准化摄取值（SUV）阈值 x（x=2、2.5、3 或 SUV 最大值×50%）测量 MTV。总糖酵解活性（TGA（x））定义为平均 SUV×MTV（x）。MTV 比定义为 CRT 前 PET MTV/CRT 后 PET MTV。SUV 比类似定义。一位病理学家使用肿瘤消退分级（TRG）量表对病理反应进行评分。
结果
中位随访时间为 1.5 年（范围，0.4-4.9 年）。CRT 前 PET 扫描的任何参数均与 TRG 或总生存（OS）无显著相关性。多个 CRT 后 MTV 值和 TGA 值与 TRG 和 OS 相关，但 MTV（2.5（Post））和 TGA（2.5（Post））相关性最强。MTV（2）比与 OS 相关。CRT 前和 CRT 后 PET 扫描的最大 SUV 或最大 SUV 比与 TRG 或 OS 均无相关性。术前治疗的患者与 PET 反应良好的根治性治疗患者的生存相似（p=0.97），与 PET 反应差的根治性治疗患者的生存显著改善（p<0.0001）。
结论
最大 SUV 不是预测或预后参数。MTV（2.5）和 TGA（2.5）是预测 CRT 后 PET 扫描反应和生存的有用标志物。MTV（2）比也与生存相关。CRT 后 PET 有可能指导 CRT 后的治疗。
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