Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
Department of Internal Medicine, University at Buffalo, Buffalo, New York.
JAMA Surg. 2015 Jun;150(6):555-62. doi: 10.1001/jamasurg.2014.3867.
Predicting complete pathologic response (CPR) preoperatively can significantly affect surgical decision making. There are conflicting data regarding positron emission tomography computed tomography (PET CT) characteristics and the ability of PET CT to predict pathologic response following neoadjuvant chemoradiotherapy in esophageal adenocarcinoma because most existing studies that include squamous histology have limited numbers and use nonstandardized PET CT imaging.
To determine if PET CT characteristics are associated with CPR in patients undergoing trimodality treatment for esophageal adenocarcinoma.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical record review was conducted at a large tertiary cancer center from a prospectively maintained database from January 1, 2005, to December 31, 2012. Inclusion criteria were patients undergoing esophagectomy for locally advanced esophageal adenocarcinoma post-neoadjuvant chemoradiotherapy with 2 standardized PET CT studies done at our institution (pre-neoadjuvant chemoradiotherapy and post-neoadjuvant chemoradiotherapy) for review. Data collected included clinical, pathologic, imaging, and treatment characteristics.
The primary study outcome was the association of PET CT characteristics with histologic confirmed pathologic response.
Of the total participants, 77 patients met the inclusion criteria. Twenty-two patients (28.6%) had CPR vs 55 patients (71.4%) who had incomplete pathologic response. The 2 groups were similar in age, sex, race/ethnicity, comorbid conditions, Eastern Cooperative Oncology Group status, tumor grade, chemotherapy, and radiation regimen and days between the 2 PET CTs. The mean prestandardized uptake variable (SUV; 14.5 vs 11.2; P = .05), δ SUV (10.3 vs 5.4; P = .02), and relative δ SUV (0.6 vs 0.4; P = .02) were significantly higher in those with CPR vs incomplete pathologic response. Using the Youden Index, a δ SUV value less than 45% was predictive of residual disease with a positive predictive value of 91.7% (95% CI, 73-99; P < .05).
To our knowledge, this is the largest study examining the role of PET CT characteristics in esophageal adenocarcinoma for patients undergoing neoadjuvant chemoradiotherapy that demonstrates that δ SUV of less than 45% is associated with patients with residual disease but not CPR. Based on the findings from our study, the current recommendation is still surgical resection regardless of the posttherapy PET SUV in the primary tumor. However, our study highlights the ability to detect patients with residual disease and the need to critically evaluate these patients for consideration of additional therapies.
术前预测完全病理缓解（CPR）可以显著影响手术决策。关于正电子发射断层扫描计算机断层扫描（PET CT）特征以及 PET CT 在接受新辅助放化疗的食管腺癌中预测病理反应的能力存在相互矛盾的数据，因为大多数包含鳞状组织学的现有研究数量有限且使用非标准化的 PET CT 成像。
确定在接受三联治疗的食管腺癌患者中，PET CT 特征是否与 CPR 相关。
设计、地点和参与者：对一家大型三级癌症中心从 2005 年 1 月 1 日至 2012 年 12 月 31 日期间前瞻性维护的数据库中进行回顾性病历审查。纳入标准为接受新辅助放化疗后接受根治性手术治疗的局部晚期食管腺癌患者，在我们机构进行了 2 次标准化 PET CT 检查（新辅助放化疗前和新辅助放化疗后）进行回顾。收集的数据包括临床、病理、影像学和治疗特征。
主要研究结果是 PET CT 特征与组织学证实的病理反应的相关性。
在总共的参与者中，有 77 名患者符合纳入标准。22 名患者（28.6%）有 CPR，55 名患者（71.4%）有不完全病理缓解。2 组在年龄、性别、种族/民族、合并症、东部合作肿瘤组状态、肿瘤分级、化疗和放疗方案以及 2 次 PET CT 之间的天数方面相似。CPR 组的标准化摄取值变量（SUV）均值（14.5 比 11.2；P = .05）、δ SUV（10.3 比 5.4；P = .02）和相对 δ SUV（0.6 比 0.4；P = .02）均明显高于不完全病理缓解组。使用 Youden 指数，δ SUV 值小于 45%可预测残留疾病，阳性预测值为 91.7%（95%CI，73-99；P < .05）。
据我们所知，这是最大的一项研究，检查了新辅助放化疗后接受食管腺癌治疗的患者的 PET CT 特征在预测 CPR 中的作用，该研究表明，小于 45%的 δ SUV 与残留疾病相关，但与 CPR 无关。基于我们研究的结果，目前的建议仍然是进行手术切除，而不管原发性肿瘤的放化疗后 PET SUV 如何。然而，我们的研究强调了检测残留疾病的能力，以及需要对这些患者进行严格评估，以考虑额外的治疗。
