18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在不明原发癌患者管理中的作用。

The role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in the management of patients with carcinoma of unknown primary.

机构信息

Radiology Department, Glasgow Royal Infirmary, UK.

出版信息

Scott Med J. 2013 Aug;58(3):154-62. doi: 10.1177/0036933013496958.

DOI:10.1177/0036933013496958

PMID:23960054

Abstract

PURPOSE

Carcinoma of unknown primary is one of the ten most frequent cancers worldwide. Its median survival time is less than 10 months. Detecting primary tumour locations and/or occult metastatic lesions may inform definitive treatment and improve patients' prognosis. We aimed to determine: (1) the sensitivity, specificity and accuracy of (18)F-fluoro-2-deoxyglucose positron emission tomography/computed tomography; (2) its detection rate of primary tumour locations and occult metastases and (3) factors associated with improved survival times.

METHODS

We retrospectively reviewed all cases in the West of Scotland for the period 1 December 2007 to 31 May 2011 that met all our selection criteria: (1) diagnosis of carcinoma of unknown primary; (2) a thorough but negative 'work-up' and (3) (18)F-fluoro-2-deoxyglucose positron emission tomography/computed tomography report. Statistical methods included frequencies, Kaplan-Meier graphs and log-rank tests to compare survival times.

RESULTS

(18)F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected primary tumour sites in 19/51 (37.3%) and occult metastases in 28/51 (54.9%) of eligible patients. Its sensitivity, specificity and accuracy were 79.2%, 70.4% and 74.5%, respectively; 20/51 (39.2%) patients died during the study period with a median survival of 8.4 months (range 21.4, SD ± 6.2). The number of metastatic locations was strongly associated with survival (p = 0.002), but detection of a primary tumour site (p = 0.174) or histopathology (p = 0.301) was not.

CONCLUSION

(18)F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected occult metastatic sites in the majority and a primary cancer location in a substantial minority of patients. Our results were comparable with international literature and may indicate that (18)F-fluoro-2-deoxyglucose positron emission tomography/computed tomography have an early role to improve the accuracy of cancer staging and to optimise carcinoma of unknown primary management.

摘要

目的

不明原发灶癌是全球最常见的十大癌症之一。其中位生存时间不足 10 个月。检测原发肿瘤部位和/或隐匿性转移病灶可能有助于确定明确的治疗方案并改善患者预后。我们旨在确定：(1)18 氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描的灵敏度、特异性和准确性；(2)其检测原发肿瘤部位和隐匿性转移的检出率，以及 (3)与改善生存时间相关的因素。

方法

我们对 2007 年 12 月 1 日至 2011 年 5 月 31 日期间在苏格兰西部地区满足所有选择标准的所有病例进行了回顾性审查：(1)诊断为不明原发灶癌；(2)进行了全面但阴性的“工作流程”检查，以及 (3)(18)氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描报告。统计方法包括频率、Kaplan-Meier 图和对数秩检验，以比较生存时间。

结果

在符合条件的 51 名患者中，18 氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描检测到 19 名患者的原发肿瘤部位(37.3%)和 28 名患者的隐匿性转移灶(54.9%)。其灵敏度、特异性和准确性分别为 79.2%、70.4%和 74.5%；51 名患者中有 20 名(39.2%)在研究期间死亡，中位生存期为 8.4 个月(范围 21.4，SD ± 6.2)。转移灶数量与生存时间密切相关(p=0.002)，但检测到原发肿瘤部位(p=0.174)或组织病理学(p=0.301)与生存时间无关。