Sheikhbahaei Sara, Wray Rick, Young Brenda, Mena Esther, Taghipour Mehdi, Rahmim Arman, Subramaniam Rathan M
aRussell H Morgan Department of Radiology and Radiological Sciences bDepartment of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine cDepartment of Health Policy and Management and Center for Health Services and Outcome Research, Johns Hopkins Bloomberg School of Public Health dArmstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Nucl Med Commun. 2016 Mar;37(3):231-8. doi: 10.1097/MNM.0000000000000436.
This study aims to evaluate the impact of therapy assessment PET/computed tomography (CT) scan on the management of locally advanced pancreatic adenocarcinoma (LAPC), and the value of qualitative versus quantitative PET/CT interpretation for patient outcome prediction.
Forty-two LAPC patients were retrospectively included. PET/CT was performed at a median of 4.6 weeks after completion of chemo ± radiotherapy to assess the primary treatment response. PET was interpreted visually using a qualitative five-point scale (Hopkins criteria for therapy assessment). Quantitative PET parameters including maximum and peak standardized uptake value (SUV max and SUV peak), total lesion glycolysis, and metabolic tumor volume (MTV) were also measured using the gradient segmentation method. Kaplan-Meier and Cox regression analyses were performed.
Thirty-five patients were followed up until death. Therapy assessment PET/CT led to a change in the overall management of 22 (52.4%) patients, prompting surgical resection (eight patients), adding radiation therapy (eight patients), or starting palliative chemotherapy (six patients). The median survival in patients with a negative or a positive PET scan, according to the Hopkins criteria, was 14.6 and 8.7 months, respectively (P=0.06). The median quantitative thresholds of SUV peak 2.64 [hazard ratio (HR)=2.67, P=0.03], total lesion glycolysis 44.0 g (HR=2.64, P=0.005), and MTV 24.7 ml (HR=2.57, P=0.008) were significant predictors of overall survival. Using combined quantitative scoring, patients with high SUV peak and high MTV (>median cut point) had a 5.45-fold (95% confidence interval: 1.76-16.87) increased risk for death compared with those with both low SUV peak and MTV (the reference group).
PET-based volumetric parameters can predict survival outcomes of patients with LAPC. A combined quantitative PET/CT scoring system provides significantly improved prognostication.
本研究旨在评估治疗评估正电子发射断层扫描/计算机断层扫描（PET/CT）对局部晚期胰腺癌（LAPC）治疗管理的影响，以及定性与定量PET/CT解读对患者预后预测的价值。
回顾性纳入42例LAPC患者。在完成化疗±放疗后中位4.6周时进行PET/CT检查，以评估初始治疗反应。PET采用定性五点量表（霍普金斯治疗评估标准）进行视觉解读。还使用梯度分割法测量了包括最大和峰值标准化摄取值（SUV max和SUV peak）、总病变糖酵解和代谢肿瘤体积（MTV）在内的定量PET参数。进行了Kaplan-Meier和Cox回归分析。
35例患者随访至死亡。治疗评估PET/CT导致22例（52.4%）患者的整体治疗管理发生改变，促使进行手术切除（8例患者）、增加放射治疗（8例患者）或开始姑息化疗（6例患者）。根据霍普金斯标准，PET扫描阴性或阳性患者的中位生存期分别为14.6个月和8.7个月（P = 0.06）。SUV peak的中位定量阈值为2.64 [风险比（HR）= 2.67，P = 0.03]、总病变糖酵解为44.0 g（HR = 2.64，P = 0.005）以及MTV为24.7 ml（HR = 2.57，P = 0.008）是总生存期的显著预测指标。使用联合定量评分，SUV peak高且MTV高（>中位切点）的患者与SUV peak和MTV均低的患者（参照组）相比，死亡风险增加5.45倍（95%置信区间：1.76 - 16.87）。
基于PET的体积参数可预测LAPC患者的生存结局。联合定量PET/CT评分系统可显著改善预后评估。
