18F-FDG PET/CT 与黑色素瘤：四次及后续治疗后随访扫描在患者管理中的价值。

18F-FDG PET/CT and Melanoma: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management.

机构信息

From the *Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD; †Boston University School of Medicine, Boston, MA; ‡Department of Oncology, Sidney Kimmel Comprehensive Cancer Centre, §Armstrong Institute for Patient Safety & Quality, Johns Hopkins School of Medicine; and ∥Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

出版信息

Clin Nucl Med. 2016 Sep;41(9):e403-9. doi: 10.1097/RLU.0000000000001275.

DOI:10.1097/RLU.0000000000001275

PMID:27355846

Abstract

PURPOSE

We aimed to evaluate the added value of performing fourth and subsequent follow-up F-FDG-PET/CT scans to clinical assessment and impact on the patient's management in patients with melanoma.

METHODS

This was a retrospective study of 232 biopsy-proven melanoma patients who underwent F-FDG-PET/CT scans. Of these, 71 patients had 4 or more follow-up F-FDG-PET/CT scans after completion of primary treatment, with a total of 246 fourth or subsequent follow-up PET/CT scans. The added value of each follow-up PET/CT scan to the patient's clinical assessment and treatment management was established. Kaplan-Meier plots with a Mantel-Cox log-rank test were used to establish the patient's overall survival.

RESULTS

Of the 246 fourth and subsequent follow-up PET/CT scans, 61% (150/246) were negative for malignancy, and 39.0% (96/246) were positive for recurrence/metastases. FDG-PET/CT was helpful in identifying malignancy in 6.5% of the scans performed without prior clinical suspicion, which ruled out malignancy in 28.5% of the scans obtained with prior clinical signs suggestive of recurrence or for secondary therapy assessment. The PET/CT scan resulted in change of the patient's management in approximately 16.7% (41/246) of the scans. Change in management was significantly greater in patients whose scans were done with prior clinical signs suggestive of malignancy, or for therapy assessment than without prior clinical suspicion (29.3% vs 4.1%; P < 0.0001). Statistically significant difference was seen in the overall survival between patients with at least 1 positive and all negative fourth and subsequent follow-up PET/CT scans at patient level (P = 0.001).

CONCLUSIONS

The fourth and subsequent F-FDG-PET/CT scans obtained after completion of primary treatment added value to clinical assessment in patients with melanoma. Patients with clinical signs suggestive of recurrence or metastases or being monitored for treatment response are more likely to benefit from the fourth or subsequent FDG PET/CT than those without prior clinical suspicion.

摘要

目的

我们旨在评估在完成初始治疗后进行第四及后续次 F-FDG-PET/CT 扫描对黑色素瘤患者的临床评估和治疗管理的影响，并分析其附加价值。

方法

这是一项回顾性研究，共纳入 232 例经活检证实的黑色素瘤患者，这些患者均行 F-FDG-PET/CT 检查。其中 71 例患者在初始治疗完成后接受了 4 次或更多次的 F-FDG-PET/CT 随访，总共进行了 246 次第四或后续次的 PET/CT 扫描。通过建立 Kaplan-Meier 图和 Mantel-Cox 对数秩检验，确定每位患者的总生存期。

结果

在 246 次第四及后续次的 PET/CT 扫描中，61%（150/246）为阴性，提示无恶性肿瘤；39.0%（96/246）为阳性，提示复发/转移。在没有临床可疑迹象的情况下，FDG-PET/CT 检查有助于发现 6.5%的恶性肿瘤，在有临床迹象提示复发或需要辅助治疗评估的情况下，28.5%的扫描结果排除了恶性肿瘤。大约 16.7%（41/246）的 PET/CT 扫描结果改变了患者的治疗方案。在有临床可疑迹象或需要辅助治疗评估的患者中，扫描结果改变患者管理的比例明显高于没有临床可疑迹象的患者（29.3%比 4.1%；P<0.0001）。在患者水平上，至少有 1 次阳性和所有阴性的第四及后续次 F-FDG-PET/CT 扫描的患者之间的总生存期存在显著差异（P=0.001）。