Sugimura Keijiro, Miyata Hiroshi, Yano Masahiko, Yanagimoto Yoshitomo, Ho Moon Jeong, Kobayashi Shogo, Takahashi Hidenori, Omori Takeshi, Ohue Masayuki, Sakon Masato
Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan.
Gen Thorac Cardiovasc Surg. 2017 Aug;65(8):455-462. doi: 10.1007/s11748-017-0786-9. Epub 2017 Jun 5.
Induction therapy followed by surgery is a promising strategy for esophageal cancer patients with invasion of the trachea/bronchus or aorta. However, no diagnostic criteria have been established to diagnose whether R0 resection can be performed. We investigated whether F-2-deoxy-D-glucose positron emission tomography (F-FDG-PET) and other modalities are useful for predicting R0 resection.
Fifty-seven patients with esophageal cancer invading the trachea/bronchus or aorta who underwent induction therapy followed by surgery were enrolled. We divided the participants into two groups, an R0 resection group (n = 43) and a non-R0 resection group (n = 14), and then compared the between-group results of three modalities, including computed tomography (CT), endoscopy and F-FDG-PET, before and after induction therapy.
The post-maximal standardized uptake value (SUV) after induction therapy in the R0 resection group was significantly lower than that in the non-R0 resection group (4.4 vs. 6.6, p = 0.005). The receiver operating characteristic curve analysis showed that the cut-off value for the post-SUV based on F-FDG-PET prediction of R0 resection was 4.7. Furthermore, a tumor reduction rate of ≥44% on CT, no residual stenosis, and no deep ulcer on endoscopy were associated with R0 resection after induction therapy (p = 0.002, p = 0.091, and p = 0.059, respectively). Multivariate logistic analyses revealed that the tumor reduction rate on CT and post-SUV <4.7 in F-FDG-PET were independent factors for R0 resection.
The post-SUV determined by F-FDG-PET and the volume reduction rate based on CT scans were useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma.
对于侵犯气管/支气管或主动脉的食管癌患者，诱导治疗后行手术是一种有前景的策略。然而，尚未建立用于诊断能否进行R0切除的诊断标准。我们研究了F-2-脱氧-D-葡萄糖正电子发射断层扫描（F-FDG-PET）及其他检查方法对预测R0切除是否有用。
纳入57例侵犯气管/支气管或主动脉且接受诱导治疗后行手术的食管癌患者。我们将参与者分为两组，R0切除组（n = 43）和非R0切除组（n = 14），然后比较诱导治疗前后三组检查方法（包括计算机断层扫描（CT）、内镜检查和F-FDG-PET）的组间结果。
诱导治疗后，R0切除组的最大标准化摄取值（SUV）显著低于非R0切除组（4.4对6.6，p = 0.005）。受试者工作特征曲线分析显示，基于F-FDG-PET预测R0切除的SUV临界值为4.7。此外，诱导治疗后CT上肿瘤缩小率≥44%、无残留狭窄以及内镜检查无深度溃疡与R0切除相关（分别为p = 0.002、p = 0.091和p = 0.059）。多因素逻辑分析显示，CT上的肿瘤缩小率和F-FDG-PET中SUV<4.7是R0切除的独立因素。
F-FDG-PET测定的SUV及基于CT扫描的体积缩小率有助于预测初始不可切除的局部晚期食管癌诱导治疗后能否进行R0切除。
