Department of Nuclear Medicine, Jeju National University Hospital, Jeju, Korea.
Eur J Nucl Med Mol Imaging. 2012 Sep;39(9):1425-34. doi: 10.1007/s00259-012-2164-2. Epub 2012 Jun 7.
The study evaluated the role of preoperative (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in the prediction of recurrent gastric cancer after curative surgical resection.
A total of 271 patients with gastric cancer who underwent (18)F-FDG PET/CT and subsequent curative surgical resection were enrolled. All patients underwent follow-up for cancer recurrence with a mean duration of 24 ± 12 months. (18)F-FDG PET/CT images were visually assessed and, in patients with positive (18)F-FDG cancer uptake, the maximum standardized uptake value (SUV(max)) of cancer lesions was measured. (18)F-FDG PET/CT findings were tested as prognostic factors for cancer recurrence and compared with conventional prognostic factors. Furthermore, (18)F-FDG PET/CT findings were assessed as prognostic factors according to histopathological subtypes.
Of 271 patients, 47 (17 %) had a recurrent event. Positive (18)F-FDG cancer uptake was shown in 149 patients (55 %). Tumour size, depth of invasion, presence of lymph node metastasis, positive (18)F-FDG uptake and SUV(max) were significantly associated with tumour recurrence in univariate analysis, while only depth of invasion, positive (18)F-FDG uptake and SUV(max) had significance in multivariate analysis. The 24-month recurrence-free survival rate was significantly higher in patients with negative (18)F-FDG uptake (95 %) than in those with positive (18)F-FDG uptake (74 %; p < 0.0001). In subgroup analysis, (18)F-FDG uptake was a significant prognostic factor in patients with tubular adenocarcinoma (p = 0.003) or poorly differentiated adenocarcinoma (p = 0.0001). However, only marginal significance was shown in patients with signet-ring cell carcinoma and mucinous carcinoma (p = 0.05).
(18)F-FDG uptake of gastric cancer is an independent and significant prognostic factor for tumour recurrence. (18)F-FDG PET/CT could provide effective information on the prognosis after surgical resection of gastric cancer, especially in tubular adenocarcinoma and poorly differentiated adenocarcinoma.
本研究评估了术前 18 氟-脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT 在预测根治性手术后胃癌复发中的作用。
共纳入 271 例接受 18F-FDG PET/CT 检查和随后根治性手术的胃癌患者。所有患者均接受癌症复发的随访，平均随访时间为 24±12 个月。对 18F-FDG PET/CT 图像进行了视觉评估，并且在 18F-FDG 摄取阳性的癌症患者中，测量了癌症病变的最大标准化摄取值（SUV(max)）。将 18F-FDG PET/CT 检查结果作为癌症复发的预后因素进行检验，并与传统预后因素进行比较。此外，根据组织病理学亚型评估了 18F-FDG PET/CT 检查结果作为预后因素的情况。
在 271 例患者中，有 47 例（17%）发生了复发事件。149 例（55%）患者 18F-FDG 摄取阳性。在单因素分析中，肿瘤大小、浸润深度、淋巴结转移、18F-FDG 摄取阳性和 SUV(max) 与肿瘤复发显著相关，而多因素分析中仅浸润深度、18F-FDG 摄取阳性和 SUV(max) 有意义。无 18F-FDG 摄取的患者 24 个月无复发生存率显著高于 18F-FDG 摄取阳性的患者（95%比 74%；p<0.0001）。在亚组分析中，18F-FDG 摄取在管状腺癌（p=0.003）或低分化腺癌（p=0.0001）患者中是一个显著的预后因素。然而，在印戒细胞癌和黏液腺癌患者中仅显示出边缘显著性（p=0.05）。
胃癌 18F-FDG 摄取是肿瘤复发的独立且显著的预后因素。18F-FDG PET/CT 可为胃癌根治性手术后的预后提供有效信息，尤其是在管状腺癌和低分化腺癌患者中。
