Leon-Ferre Roberto A, Kottschade Lisa A, Block Matthew S, McWilliams Robert R, Dronca Roxana S, Creagan Edward T, Allred Jacob B, Lowe Val J, Markovic Svetomir N
Departments of aOncology bRadiology cDepartment of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Melanoma Res. 2017 Aug;27(4):335-341. doi: 10.1097/CMR.0000000000000344.
The optimal surveillance for patients with resected high-risk melanoma is controversial. Select locoregional or oligometastatic recurrences can be cured with salvage resection. Data on the ability of PET/CT to detect such recurrences are sparse. We evaluated whether surveillance PET/CT in patients with resected stage III-IV melanoma led to detection of clinically occult recurrences amenable to curative-intent salvage treatment. We retrospectively identified 1429 melanoma patients who underwent PET/CT between January 2008 and October 2012 at Mayo Clinic (Rochester, Minnesota). A total of 1130 were excluded because of stage I-II, ocular or mucosal melanoma, incomplete resection, PET/CT not performed for surveillance or performed at a different institution, and records not available. A total of 299 patients were eligible. Overall, 162 (52%) patients developed recurrence [locoregional: 77 (48%), distant: 85 (52%)]. The first recurrence was clinically occult in 98 (60%) and clinically evident in 64 (40%). Clinically evident recurrences were more often superficial (skin, subcutaneous, or nodal) or in the brain, whereas clinically occult recurrences more often visceral. Overall, 90% of all recurrences were detected by 2.8 years. In all, 70% of patients with recurrence underwent curative-intent salvage treatment (locoregional: 94%, distant: 48%), with similar rates for clinically occult versus clinically evident recurrences (66 vs. 75%, P=0.240). Overall survival was superior among those who underwent curative-intent salvage treatment [5.9 vs. 1.2 years; hazard ratio=4.27, 95% confidence interval (CI)=2.68-6.80; P<0.001], despite 79% developing recurrence again. PET/CT had high sensitivity (88%, 95% CI=79.94-93.31%), specificity (90%, 95% CI=88.56-91.56%), and negative predictive value (99%, 95% CI=98.46-99.52%). However, the positive predictive value was only 37% (95% CI=31.32-43.68%). In patients with resected stage III-IV melanoma, surveillance PET/CT detected a large proportion of clinically occult recurrences amenable to curative-intent salvage treatment. Despite a high rate of second relapse, curative-intent salvage treatment was associated with superior overall survival. Even though PET/CT had high sensitivity, specificity, and negative predictive value, positive predictive value was poor, highlighting the need for histologic confirmation of PET/CT-detected abnormalities.
对于接受过手术的高危黑色素瘤患者，最佳监测方案存在争议。部分局部区域或寡转移复发可通过挽救性切除治愈。关于PET/CT检测此类复发能力的数据较为稀少。我们评估了对接受过手术的III-IV期黑色素瘤患者进行PET/CT监测，是否能检测出适合进行根治性挽救治疗的临床隐匿性复发。我们回顾性纳入了2008年1月至2012年10月在梅奥诊所（明尼苏达州罗切斯特）接受PET/CT检查的1429例黑色素瘤患者。由于处于I-II期、眼部或黏膜黑色素瘤、切除不完全、未因监测目的进行PET/CT检查或在其他机构进行检查以及记录不可用，共排除1130例。共有299例患者符合条件。总体而言，162例（52%）患者出现复发[局部区域：77例（48%），远处：85例（52%）]。首次复发时，98例（60%）为临床隐匿性，64例（40%）为临床显性。临床显性复发更常见于浅表部位（皮肤、皮下或淋巴结）或脑部，而临床隐匿性复发更常见于内脏。总体而言，90%的复发在2.8年内被检测到。共有70%的复发患者接受了根治性挽救治疗（局部区域：94%，远处：48%），临床隐匿性复发与临床显性复发的治疗率相似（66%对75%，P = 0.240）。接受根治性挽救治疗的患者总生存期更长[5.9年对1.2年；风险比 = 4.27，95%置信区间（CI）= 2.68 - 6.80；P < 0.001]，尽管79%的患者再次出现复发。PET/CT具有较高的敏感性（88%，95% CI = 79.94 - 93.31%）、特异性（90%，95% CI = 88.56 - 91.56%）和阴性预测值（99%，95% CI = 98.46 - 99.52%）。然而，阳性预测值仅为37%（95% CI = 31.32 - 43.68%）。对于接受过手术的III-IV期黑色素瘤患者，PET/CT监测检测出了很大一部分适合进行根治性挽救治疗的临床隐匿性复发。尽管二次复发率较高，但根治性挽救治疗与更好的总生存期相关。尽管PET/CT具有较高的敏感性、特异性和阴性预测值，但其阳性预测值较差，这突出了对PET/CT检测到的异常进行组织学确认的必要性。
