Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia.
Ann Surg. 2018 May;267(5):929-935. doi: 10.1097/SLA.0000000000002170.
The aim of this study was to evaluate overall survival (OS) and cancer recurrence for patients with indeterminate positron emission tomography (PET) scan for extrahepatic disease (EHD) before liver resection (LR) for colorectal liver metastases (CLMs).
Indeterminate EHD as determined by PET imaging indicates a probability of extrahepatic malignancy and potentially excludes patients from undergoing LR for CLM.
In a retrospective analysis of prospectively collected data from February 2006 to December 2014, OS for patients with indeterminate EHD on FDG-PET scan before LR for CLM was performed using standard survival analysis methods, including Kaplan-Meier estimator and Cox proportional hazard models for multivariate analyses. Postoperative imaging was used as reference to evaluate the association between indeterminate EHD and recurrence.
Of 267 patients with PET scans before LR, 197 patients had no EHD and 70 patients had indeterminate EHD. Median follow-up was 33 months. The estimated 5-year OS was 60.8% versus 59.4% for indeterminate and absent EHD, respectively (P = 0.625). Disease-free survival was comparable between both groups (P = 0.975) and overall recurrence was 57.1% and 59.5% for indeterminate and absent EHD, respectively (P = 0.742). About 16.9% of recurrence was associated with the site of indeterminate EHD, with 80% of associated recurrence occurring in the thorax.
The site of indeterminate EHD appears to have a predictive value for recurrence, with indeterminate EHD in the thorax having a higher probability of malignancy. The evidence in this report supports the critical evaluation of PET scan results and that patients are not denied potential curative LR unless the evidence for unresectable EHD is certain.
本研究旨在评估结直肠癌肝转移（CLM）患者行肝切除术（LR）前正电子发射断层扫描（PET）显示肝外疾病（EHD）结果不确定患者的总生存（OS）和癌症复发情况。
PET 成像确定的 EHD 结果不确定表示存在肝外恶性肿瘤的可能性，并可能使患者无法接受 CLM 的 LR。
对 2006 年 2 月至 2014 年 12 月前瞻性收集的数据进行回顾性分析，采用标准生存分析方法评估 LR 前 FDG-PET 扫描 EHD 结果不确定患者的 OS，包括 Kaplan-Meier 估计器和 Cox 比例风险模型进行多变量分析。术后影像学检查用于评估 EHD 结果不确定与复发之间的关系。
267 例接受 LR 前 PET 扫描的患者中，197 例无 EHD，70 例 EHD 结果不确定。中位随访时间为 33 个月。估计的 5 年 OS 分别为不确定 EHD 和无 EHD 组的 60.8%和 59.4%（P=0.625）。两组无疾病生存情况无差异（P=0.975），总复发率分别为不确定 EHD 和无 EHD 组的 57.1%和 59.5%（P=0.742）。不确定 EHD 部位与约 16.9%的复发相关，80%的相关复发发生在胸部。
EHD 结果不确定的部位似乎对复发具有预测价值，胸部 EHD 结果不确定的患者恶性肿瘤的可能性更高。本报告中的证据支持对 PET 扫描结果进行批判性评估，除非 EHD 无法切除的证据确凿，否则不应拒绝患者接受潜在治愈性 LR 的机会。
