van de Putte E E Fransen, Vegt E, Mertens L S, Bruining A, Hendricksen K, van der Heijden M S, Horenblas S, van Rhijn B W G
Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Int Urol Nephrol. 2017 Sep;49(9):1585-1591. doi: 10.1007/s11255-017-1637-4. Epub 2017 Jul 3.
We investigated the accuracy of FDG-PET/CT response identification following neoadjuvant or induction chemotherapy (NAIC) for invasive bladder cancer (BC) as to better select patients for radical cystectomy (RC).
Between 2010 and 2014, 37 cT1-4N1-3 BC patients received a FDG-PET/CT before and after NAIC followed by RC. Metabolic lymph node (LN) response was evaluated according to EORTC recommendations. Additionally, primary tumor response was evaluated for 23 patients by means of delayed pelvic imaging after forced diuresis. Gold standard was response on pathologic analysis of RC specimens. Response was defined as partial response (pPR, any pathologic downstaging) or complete response (pCR, <ypT1N0). Cancer-specific survival (CSS) was correlated with pCR and metabolic CR.
Twenty-four cN+ patients achieved LN pCR. FDG-PET/CT identified pCR with 67% sensitivity and 46% specificity. Primary tumor response was evaluable for 17/23 patients, of whom 12 were responders. Tumor downstaging (pPR or pCR) was identified with 83% sensitivity and 80% specificity. Tumor pCR was detected with 70% sensitivity and 71% specificity. pCR of overall disease (primary tumor and LNs, n = 17) was detected with 67% sensitivity and 75% specificity. CSS was positively associated with pathologic CR (HR 0.16, p = 0.027), but not with metabolic CR (HR 0.560, p = 0.612).
FDG-PET/CT can accurately distinguish primary tumor downstaging from non-response, which suggests that response monitoring (in cN0 patients) might be used to adjust neoadjuvant treatment. pCR identification is less accurate, especially for LN metastases, which suggests that FDG-PET/CT cannot be used to select patients for RC.
我们研究了氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在浸润性膀胱癌（BC）新辅助或诱导化疗（NAIC）后反应识别方面的准确性，以便更好地选择接受根治性膀胱切除术（RC）的患者。
2010年至2014年间，37例cT1-4N1-3期BC患者在NAIC前后接受了FDG-PET/CT检查，随后接受了RC。根据欧洲癌症研究与治疗组织（EORTC）的建议评估代谢性淋巴结（LN）反应。此外，对23例患者通过强制利尿后的盆腔延迟成像评估原发肿瘤反应。金标准是RC标本的病理分析结果。反应定义为部分反应（pPR，任何病理降期）或完全反应（pCR，<ypT1N0）。癌症特异性生存（CSS）与pCR和代谢性CR相关。
24例cN+患者实现了LN pCR。FDG-PET/CT识别pCR的敏感性为67%，特异性为46%。17/23例患者的原发肿瘤反应可评估，其中12例为反应者。肿瘤降期（pPR或pCR）的识别敏感性为83%，特异性为80%。肿瘤pCR的检测敏感性为70%，特异性为71%。整体疾病（原发肿瘤和LN，n = 十七）的pCR检测敏感性为67%，特异性为75%。CSS与病理CR呈正相关（风险比0.16，p = 0.027），但与代谢性CR无关（风险比0.560，p = 0.612）。
FDG-PET/CT可以准确区分原发肿瘤降期与无反应，这表明反应监测（在cN0患者中）可用于调整新辅助治疗。pCR识别的准确性较低，尤其是对于LN转移，这表明FDG-PET/CT不能用于选择接受RC的患者。
