Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Abdom Radiol (NY). 2018 May;43(5):1152-1158. doi: 10.1007/s00261-017-1287-0.
The computed tomography (CT) morphologic response of colorectal liver metastases (CLM) after chemotherapy is reportedly correlated with pathologic response and survival outcomes of patients undergoing surgery. However, they are rather subjective criteria and not evaluable without adequate quality of contrast-enhanced CT images. This study sought the potential use of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) as an objective substitute for predicting pathological viability of CLM after chemotherapy.
Predictive ability of tumor viability of ≤10% was compared between FDG-PET/CT and contrast-enhanced CT in 34 patients who underwent curative surgical resection for CLM after chemotherapy. The CT morphology and response were defined according to the reported criteria (Chun YS, JAMA 2009).
The mean standard uptake value (SUV-mean) in CLM was significantly lower in patients with group 1 and group 2 CT morphology (median, 2.53 and 3.00, respectively) than in group 3 (median, 3.32). The tumor SUV-mean showed moderate correlation with the tumor pathologic viability (r = 0.660, P < 0.0001). A receiver operating characteristic curve analysis revealed that both the tumor SUV-mean (area under the curve [AUC], 0.916; the cut-off value, 3.00) and the CT morphology (AUC, 0.882) have excellent predictive power for ≤10% of tumor viability, while degree of tumor shrinkage showed lower predictive power (AUC, 0.692).
FDG-PET shows significant correlation with pathologic viability of CLM after chemotherapy and may offer additional objective information for estimating tumor viability when the CT morphologic response is not evaluable.
据报道，结直肠癌肝转移（CLM）患者化疗后 CT 形态学反应与手术患者的病理反应和生存结果相关。然而，这些反应是相当主观的标准，如果没有足够质量的增强 CT 图像则无法评估。本研究旨在探讨氟-18-氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）作为预测 CLM 化疗后病理活力的客观替代方法的潜在用途。
在 34 例接受 CLM 化疗后根治性手术的患者中，比较了 FDG-PET/CT 和增强 CT 在预测肿瘤活力≤10%方面的能力。根据报告的标准（Chun YS，JAMA 2009）定义 CT 形态和反应。
CLM 的平均标准摄取值（SUV-mean）在 CT 形态为 1 组和 2 组（中位数分别为 2.53 和 3.00）的患者中明显低于 CT 形态为 3 组（中位数为 3.32）。肿瘤 SUV-mean 与肿瘤病理活力呈中度相关（r=0.660，P<0.0001）。受试者工作特征曲线分析显示，肿瘤 SUV-mean（曲线下面积[AUC]，0.916；截断值，3.00）和 CT 形态（AUC，0.882）均对肿瘤活力≤10%具有优异的预测能力，而肿瘤退缩程度的预测能力较低（AUC，0.692）。
FDG-PET 与 CLM 化疗后病理活力显著相关，当 CT 形态反应不可评估时，它可能为评估肿瘤活力提供额外的客观信息。
