Anderegg Maarten C J, de Groof Elisabeth J, Gisbertz Suzanne S, Bennink Roel J, Lagarde Sjoerd M, Klinkenbijl Jean H G, Dijkgraaf Marcel G W, Bergman Jacques J G H M, Hulshof Maarten C C M, van Laarhoven Hanneke W M, van Berge Henegouwen Mark I
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands.
PLoS One. 2015 Nov 3;10(11):e0133690. doi: 10.1371/journal.pone.0133690. eCollection 2015.
Prognosis of esophageal cancer patients can be significantly improved by neoadjuvant chemoradiotherapy (nCRT). Given the aggressive nature of esophageal tumors, it is conceivable that in a significant portion of patients treated with nCRT, dissemination already becomes manifest during the period of nCRT. The aim of this retrospective study was to determine the value and diagnostic accuracy of PET-CT after neoadjuvant chemoradiotherapy to identify patients with metastases preoperatively in order to prevent non-curative surgery.
From January 2011 until February 2013 esophageal cancer patients deemed eligible for a curative approach with nCRT and surgical resection underwent a PET-CT after completion of nCRT. If abnormalities on PET-CT were suspected metastases, histological proof was acquired. A clinical decision model was designed to assess the cost-effectiveness of this diagnostic strategy.
156 patients underwent a PET-CT after nCRT. In 31 patients (19.9%) PET-CT showed abnormalities suspicious for dissemination, resulting in 17 cases of proven metastases (10.9%). Of the patients without proven metastases 133 patients were operated. In 6 of these 133 cases distant metastases were detected intraoperatively, corresponding to 4.5% false-negative results. The standard introduction of a post-neoadjuvant therapy PET-CT led to a reduction of overall health care costs per patient compared to a scenario without restaging with PET-CT ($34,088 vs. $36,490).
In 10.9% of esophageal cancer patients distant metastases were detected by standard PET-CT after neoadjuvant chemoradiotherapy. To avoid non-curative resections we advocate post-neoadjuvant therapy PET-CT as a cost-effective step in the standard work-up of candidates for surgery.
新辅助放化疗（nCRT）可显著改善食管癌患者的预后。鉴于食管肿瘤的侵袭性，可想而知，在接受nCRT治疗的相当一部分患者中，在nCRT期间转移就已显现。这项回顾性研究的目的是确定新辅助放化疗后PET-CT在术前识别有转移患者以预防非根治性手术方面的价值和诊断准确性。
2011年1月至2013年2月，符合nCRT及手术切除根治性治疗标准的食管癌患者在nCRT完成后接受PET-CT检查。如果PET-CT上的异常怀疑为转移，则获取组织学证据。设计了一个临床决策模型来评估这种诊断策略的成本效益。
156例患者在nCRT后接受了PET-CT检查。31例患者（19.9%）的PET-CT显示有可疑转移的异常，最终确诊17例转移（10.9%）。在未确诊转移的患者中，133例接受了手术。在这133例患者中有6例术中发现远处转移，对应4.5%的假阴性结果。与不进行PET-CT再分期的情况相比，新辅助治疗后常规引入PET-CT导致每位患者的总体医疗费用降低（34,088美元对36,490美元）。
在10.9%的食管癌患者中，新辅助放化疗后通过标准PET-CT检测到远处转移。为避免非根治性切除，我们提倡新辅助治疗后PET-CT作为手术候选者标准检查中具有成本效益的一步。
