Choi Ju Young, Shim Ki Nam, Kim Seong Eun, Jung Hye Kyung, Jung Sung Ae, Yoo Kwon
Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2014 Dec;64(6):340-7. doi: 10.4166/kjg.2014.64.6.340.
BACKGROUND/AIMS: Accurate preoperative detection of regional lymph nodes and evaluation of tumor resectability is critical to determining the most adequate therapy for gastric cancer. The aim of this study is to identify a possible link between 18F-fluorodeoxyglucose (18F-FDG) uptake on PET scan combined with CT scan (PET/CT) and predictions of lymph node metastasis and non-curative surgery.
This study included 156 gastric cancer patients who underwent preoperative 18F-FDG PET/CT and surgery. In cases with perceptible FDG uptake in the primary tumor or lymph nodes, the maximum standardized uptake value (SUVmax) was calculated.
In multivariate analysis, non-curative surgery (OR, 11.05; 95% CI, 1.10-111.08; p=0.041), tumor size (≥3 cm) (OR, 7.39; 95% CI, 2.41-22.70; p<0.001), and lymph node metastasis (OR, 5.47; 95% CI, 2.05-14.64; p=0.001) were significant independent predictors for 18F-FDG uptake in the primary tumors. Tumor size (tumor size ≥3 cm) (OR, 3.15; 95% CI, 1.16-8.58; p=0.025) and lymph node metastasis (OR, 3.36; 95% CI, 1.23-9.14; p=0.018) showed significant association with 18F-FDG uptake in lymph node. When the SUVmax of the primary gastric tumor was greater than 3.75, the sensitivity and specificity of PET/CT with regard to the diagnosis of metastatic lymph node were 73.5% and 74.5%. When the SUVmax of the primary gastric tumor was greater than 4.35 and the FDG uptake of lymph nodes was positive, non-curative surgery was predicted with a sensitivity of 58.8% and specificity of 91.6%.
A high FDG uptake of the gastric tumor was related to histologic positive lymph nodes and non-curative surgery.
背景/目的：术前准确检测区域淋巴结并评估肿瘤可切除性对于确定胃癌最适当的治疗方法至关重要。本研究的目的是确定正电子发射断层扫描（PET）联合计算机断层扫描（CT）（PET/CT）上的18F-氟脱氧葡萄糖（18F-FDG）摄取与淋巴结转移预测及非根治性手术之间的可能联系。
本研究纳入了156例行术前18F-FDG PET/CT及手术的胃癌患者。对于原发肿瘤或淋巴结有明显FDG摄取的病例，计算最大标准化摄取值（SUVmax）。
多因素分析显示，非根治性手术（比值比[OR]，11.05；95%置信区间[CI]，1.10 - 111.08；P = 0.041）、肿瘤大小（≥3 cm）（OR，7.39；95% CI，2.41 - 2).70；P < 0.001）和淋巴结转移（OR，5.47；95% CI，2.05 - 14.64；P = 0.001）是原发肿瘤18F-FDG摄取的显著独立预测因素。肿瘤大小（肿瘤大小≥3 cm）（OR，3.15；95% CI，1.16 - 8.58；P = 0.025）和淋巴结转移（OR，3.36；95% CI，1.23 - 9.14；P = 0.018）与淋巴结中18F-FDG摄取显著相关。当原发性胃肿瘤的SUVmax大于3.75时，PET/CT诊断转移性淋巴结的敏感性和特异性分别为73.5%和74.5%。当原发性胃肿瘤的SUVmax大于4.35且淋巴结FDG摄取为阳性时，预测非根治性手术的敏感性为58.8%，特异性为91.6%。
胃肿瘤的高FDG摄取与组织学证实的阳性淋巴结及非根治性手术有关。
