Alongi Pierpaolo, Picchio Maria, Zattoni Fabio, Spallino Marianna, Gianolli Luigi, Saladini Giorgio, Evangelista Laura
Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy.
Eur J Nucl Med Mol Imaging. 2016 Mar;43(3):464-73. doi: 10.1007/s00259-015-3159-6. Epub 2015 Aug 14.
The purpose of our study was 1) to evaluate the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), 2) to assess the impact of FDG PET/CT on treatment decision-making, and 3) to estimate the prognostic value of FDG PET/CT in the restaging process among patients with renal cell carcinoma (RCC).
From the FDG PET/CT databases of San Raffaele Hospital in Milan, Italy, and the Veneto Institute of Oncology in Padua, Italy, we selected 104 patients with a certain diagnosis of RCC after surgery, and for whom at least 24 months of post-surgical FDG PET/CT, clinical, and instrumental follow-up data was available. The sensitivity and specificity of FDG PET/CT were assessed by histology and/or other imaging as standard of reference. Progression-free survival (PFS) and overall survival (OS) were computed using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used to identify predictors of outcome.
FDG PET/CT resulted in a positive diagnosis in 58 patients and a negative diagnosis in 46 patients. Sensitivity and specificity were 74% and 80%, respectively. FDG PET/CT findings influenced therapeutic management in 45/104 cases (43%). After a median follow-up period of 37 months (± standard deviation 12.9), 51 (49%) patients had recurrence of disease, and 26 (25%) had died. In analysis of OS, positive versus negative FDG PET/CT was associated with worse cumulative survival rates over a 5-year period (19% vs. 69%, respectively; p <0.05). Similarly, a positive FDG PET/CT correlated with a lower 3-year PFS rate. In addition, univariate and multivariate analysis revealed that a positive scan, alone or in combination with disease stage III-IV or nuclear grading 3-4, was associated with high risk of progression (multivariate analysis = hazard ratios [HRs] of 4.01, 3.7, and 2.8, respectively; all p < 0.05).
FDG PET/CT is a valuable tool both in treatment decision-making and for predicting survival and progression in patients affected by RCC.
我们研究的目的是：1）评估18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）的诊断性能；2）评估FDG PET/CT对治疗决策的影响；3）评估FDG PET/CT在肾细胞癌（RCC）患者再分期过程中的预后价值。
从意大利米兰圣拉斐尔医院和意大利帕多瓦肿瘤研究所的FDG PET/CT数据库中，我们选取了104例术后确诊为RCC的患者，这些患者术后至少有24个月的FDG PET/CT、临床及影像学随访数据。以组织学和/或其他影像学检查作为参考标准评估FDG PET/CT的敏感性和特异性。采用Kaplan-Meier法计算无进展生存期（PFS）和总生存期（OS）。使用单因素和多因素Cox比例风险模型来确定预后的预测因素。
FDG PET/CT检查结果为阳性的患者有58例，阴性的有46例。敏感性和特异性分别为74%和80%。FDG PET/CT检查结果影响了45/104例（43%）患者的治疗方案。中位随访期为37个月（±标准差12.9）后，51例（49%）患者疾病复发，26例（25%）患者死亡。在总生存期分析中，FDG PET/CT检查结果为阳性与阴性的患者在5年期间的累积生存率较差相关（分别为19%和69%；p<0.05）。同样，FDG PET/CT检查结果为阳性与较低的3年无进展生存率相关。此外，单因素和多因素分析显示，阳性扫描结果单独或与疾病III-IV期或核分级3-4合并时，与高进展风险相关（多因素分析=风险比[HRs]分别为4.01、3.7和2.8；均p<0.05）。
FDG PET/CT在RCC患者的治疗决策以及预测生存和进展方面都是一种有价值的工具。
