Bunting David M, Lai Wesley W, Berrisford Richard G, Wheatley Tim J, Drake Brent, Sanders Grant
Peninsula Oesophago-gastric Unit, Derriford Hospital, Plymouth, Devon, PL6 8DH, UK,
World J Surg. 2015 Apr;39(4):1000-7. doi: 10.1007/s00268-014-2892-5.
Positron emission tomography-computed tomography (PET-CT) scanning is used routinely in the staging of oesophageal cancer to identify occult metastases not apparent on CT and changes the management in typically 3-18% patients. The authors aim to re-evaluate its role in the management of oesophageal cancer, investigating whether it is possible to identify a group of patients that will not benefit and can safely be spared from this investigation.
Consecutive patients with oesophageal cancer undergoing PET-CT staging between 2010 and 2013 were identified from a specialist modern multidisciplinary team database. Without knowledge of the PET-CT result, patients were stratified into low-risk or high-risk groups according to the likelihood of identifying metastatic disease on PET-CT based on specified criteria routinely available from endoscopy and CT reports. Clinical outcomes in the two groups were investigated.
In 383 undergoing PET-CT, metastatic disease was identified in 52 (13.6%) patients. Eighty-three patients were stratified as low risk and 300 as high risk. None of the low-risk patients went on to have metastatic disease identified on PET-CT. Of the high-risk patients, 17% had metastatic disease identified on PET-CT.
In one of the largest studies to date investigating the influence of staging PET-CT on management of patients with oesophageal cancer, the authors report a classification based on endoscopy/CT criteria is able to accurately stratify patients according to the risk of having metastatic disease. This could be used to avoid unnecessary PET-CT 22% of patients, saving cost, inconvenience and reducing potential delay to definitive treatment in this group.
正电子发射断层扫描-计算机断层扫描（PET-CT）常用于食管癌分期，以识别CT上不明显的隐匿性转移灶，通常会改变3%-18%患者的治疗方案。作者旨在重新评估其在食管癌治疗中的作用，研究是否有可能识别出一组无法从该检查中获益且可安全免去该项检查的患者。
从一个专业的现代多学科团队数据库中，找出2010年至2013年间接受PET-CT分期的连续性食管癌患者。在不了解PET-CT结果的情况下，根据内镜检查和CT报告中常规可得的特定标准，将患者按照PET-CT上发现转移性疾病的可能性分为低风险组或高风险组。研究两组患者的临床结局。
在383例接受PET-CT检查的患者中，52例（13.6%）发现有转移性疾病。83例患者被分层为低风险组，300例为高风险组。低风险组患者在PET-CT上均未发现转移性疾病。在高风险组患者中，17%在PET-CT上发现有转移性疾病。
在迄今为止最大的一项研究之一中，作者调查了PET-CT分期对食管癌患者治疗的影响，报告称基于内镜检查/CT标准的分类能够根据发生转移性疾病的风险准确地对患者进行分层。这可用于避免22%的患者进行不必要的PET-CT检查，节省成本、减少不便，并减少该组患者确定性治疗的潜在延迟。
