Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.
Clin Cancer Res. 2016 Apr 1;22(7):1603-10. doi: 10.1158/1078-0432.CCR-14-3235. Epub 2015 Nov 25.
To evaluate the feasibility of early metabolic change assessed by PET in predicting clinical response to chemotherapy and investigate its prognostic value in patients with advanced gastric cancer.
A total of 64 patients with advanced gastric cancer were prospectively enrolled and examined by PET with (18)F-fluorodeoxyglucose (FDG) and (18)F-fluoro-3'-deoxy-3'-L-fluorothymidine (FLT) at baseline and 14 days after treatment initiation. PET findings were analyzed for the correlation with best clinical response of patients, disease control status, and survival after identifying the threshold of metabolic change percentage by ROC analysis.
For FDG-PET, the total uptake value reduction percentage (δ-SUV) of 40% was the cut-off point with the maximum of sensitivity (70%) and specificity (83%) to predict clinical responding and that of prediction for disease control status was 30%, with the highest sensitivity (58%) and specificity (100%). The δ-SUV of FLT-PET played no predictive role for clinical response (AUC = 0.62; P= 0.134) and disease control (AUC = 0.66; P= 0.157). The univariate Cox regression analysis revealed no significant prognostic impact. FDG uptake reduction in liver metastases could predict both clinical response (P= 0.010) and disease control status (P= 0.002) at thresholds of 35% and 15%, respectively. Those with greater FDG uptake reduction in liver lesions had a longer overall survival (P= 0.004).
Early metabolic change in FDG-PET might be a predictive marker for response and disease control in advanced gastric cancer. Early FDG uptake change in liver metastases might be a useful prognostic factor and needs further exploration.
评估正电子发射断层扫描（PET）早期代谢变化预测化疗临床反应的可行性，并探讨其在晚期胃癌患者中的预后价值。
前瞻性纳入 64 例晚期胃癌患者，分别在基线和治疗开始后 14 天进行 18F-氟代脱氧葡萄糖（FDG）和 18F-氟代-3'-去氧-3'-L-氟代胸苷（FLT）PET 检查。通过 ROC 分析确定代谢变化百分比的阈值，对 PET 结果与患者最佳临床反应、疾病控制状态和生存情况的相关性进行分析。
对于 FDG-PET，总摄取值减少百分比（δ-SUV）为 40%时为预测临床反应的最佳截断点，具有最高的敏感性（70%）和特异性（83%），预测疾病控制状态的最佳截断点为 30%，具有最高的敏感性（58%）和特异性（100%）。FLT-PET 的 SUV 变化对临床反应（AUC = 0.62；P= 0.134）和疾病控制（AUC = 0.66；P= 0.157）无预测作用。单因素 Cox 回归分析显示，其对预后无显著影响。肝转移灶 FDG 摄取减少可分别在 35%和 15%的阈值下预测临床反应（P= 0.010）和疾病控制状态（P= 0.002）。肝转移灶 FDG 摄取减少越多，总生存期越长（P= 0.004）。
FDG-PET 早期代谢变化可能是晚期胃癌反应和疾病控制的预测标志物。肝转移灶 FDG 摄取早期变化可能是一个有用的预后因素，需要进一步探讨。
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