胃和胃食管结合部腺癌患者治疗后/术前 PET 反应不是结局的独立预测因素。

Post-Treatment/Pre-operative PET Response Is Not an Independent Predictor of Outcomes for Patients With Gastric and GEJ Adenocarcinoma.

机构信息

Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

出版信息

Ann Surg. 2018 May;267(5):898-904. doi: 10.1097/SLA.0000000000002306.

DOI:10.1097/SLA.0000000000002306

PMID:28767564

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5794647/

Abstract

OBJECTIVE

To determine whether changes in positron emission tomography (PET) avidity correlated with histologic response and were independently associated with outcome.

BACKGROUND

The implications of metabolic response to neoadjuvant therapy as measured by repeat PET imaging remain ill-defined for patients with gastric and gastroesophageal junction (GEJ) cancers.

METHODS

We identified patients with gastric and GEJ adenocarcinoma who were evaluated with PET imaging before and following neoadjuvant treatment, and subsequently underwent curative resections. Spearman rank correlation and Cox proportional hazards regression were used to evaluate standardized uptake value (SUV) and histologic response, pathologic parameters, and disease-specific survival (DSS).

RESULTS

From 2002 to 2013, 192 patients met our inclusion criteria. The median SUVmax response was 57.3% (range: -110% to 100%) for patients with GEJ cancers, with a corresponding median pathologic treatment response of 80% (range: 0% to 100%). The median SUVmax response was 32.5% (-230% to 100%) for patients with gastric cancers, with a corresponding median pathologic treatment response of 35% (range: 0% to 100%). The Spearman correlation between SUVmax response and histologic response was significant for patients with GEJ (rho = 0.19, P = 0.04) and gastric (rho = 0.44, P < 0.0001) cancers. For patients with GEJ (P <0.0001 to 0.046) and gastric cancers (P = 0.0003 to 0.016), histopathologic response and tumor staging predicted DSS. SUVmax response failed to demonstrate a relationship with DSS when entered into multivariable models containing conventional pathologic variables.

CONCLUSION

Following completion of neoadjuvant therapy for gastric and GEJ adenocarcinoma, histopathologic staging remains the best predictor of outcome. Repeat post-treatment/preoperative PET imaging for the purpose of prognostication is of limited value.

摘要

目的

确定正电子发射断层扫描（PET）摄取的变化是否与组织学反应相关，并且是否与结果独立相关。

背景

对于接受新辅助治疗的胃癌和胃食管交界处（GEJ）癌症患者，通过重复 PET 成像测量的代谢反应的意义仍然不明确。

方法

我们确定了接受新辅助治疗前后接受 PET 成像评估且随后接受根治性切除术的胃和 GEJ 腺癌患者。使用 Spearman 等级相关和 Cox 比例风险回归评估标准化摄取值（SUV）和组织学反应、病理参数以及疾病特异性生存（DSS）。

结果

在 2002 年至 2013 年期间，共有 192 名患者符合我们的纳入标准。GEJ 癌症患者 SUVmax 反应的中位数为 57.3%（范围：-110%至 100%），相应的病理治疗反应中位数为 80%（范围：0%至 100%）。胃腺癌患者 SUVmax 反应的中位数为 32.5%（-230%至 100%），相应的病理治疗反应中位数为 35%（范围：0%至 100%）。对于 GEJ（rho=0.19，P=0.04）和胃（rho=0.44，P<0.0001）癌症患者，SUVmax 反应与组织学反应之间的 Spearman 相关性具有统计学意义。对于 GEJ（P<0.0001 至 0.046）和胃（P=0.0003 至 0.016）癌症患者，组织病理学反应和肿瘤分期预测 DSS。当将传统病理变量包含在多变量模型中时，SUVmax 反应未能显示与 DSS 的关系。