Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
Department of Oncology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
Br J Surg. 2018 Mar;105(4):419-428. doi: 10.1002/bjs.10712. Epub 2018 Feb 8.
The aim of this prospective study was to assess whether [ F]fluorodeoxyglucose PET can be used to predict histopathological response early in the course of neoadjuvant chemotherapy in patients with adenocarcinoma of the oesophagus and oesophagogastric junction.
Following the PET response criteria in solid tumours (PERCIST 1.0) as a standardized method for semiquantitative assessment of metabolic response, FDG-PET/CT was performed before (PET1) and after (PET2) initiation of the first cycle of chemotherapy. The relative changes in the peak standardized uptake value (ΔSUL) and total lesion glycolysis (ΔTLG) between PET1 and PET2 were correlated with histopathological response, defined as less than 50 per cent viable tumour cells in the resection specimen. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value with the highest accuracy of histopathological response prediction.
PET2 was performed a median of 16 (range 12-22) days after the start of chemotherapy. Some 27 of 90 patients who underwent surgery had a histopathological response. There was no association between the median ΔSUL or median ΔTLG and the histopathological response. A post hoc analysis in 47 patients with PET2 performed 16 days or less after the start of chemotherapy showed that ΔTLG, but not ΔSUL, was associated with the histopathological response (P = 0·009). The optimal cut-off value of ΔTLG was 66 per cent or more.
FDG-PET/CT after the first cycle of chemotherapy does not predict histopathological response in patients with adenocarcinoma of the oesophagus and oesophagogastric junction.
本前瞻性研究旨在评估氟[18F]脱氧葡萄糖正电子发射断层扫描（FDG-PET）是否可用于预测新辅助化疗早期阶段食管腺癌和食管胃交界腺癌患者的组织病理学反应。
采用实体瘤疗效评价标准 1.0（PERCIST 1.0）作为半定量评估代谢反应的标准化方法，在化疗第一周期开始前（PET1）和开始后（PET2）进行 FDG-PET/CT。将 PET1 和 PET2 之间的最大标准化摄取值（ΔSUL）和总病变糖酵解（ΔTLG）的相对变化与组织病理学反应相关联，组织病理学反应定义为切除标本中存活肿瘤细胞少于 50%。采用受试者工作特征（ROC）曲线分析确定预测组织病理学反应的最佳截断值，以获得最高的准确性。
PET2 于化疗开始后中位数 16 天（范围 12-22 天）进行。90 例行手术的患者中，27 例有组织病理学反应。ΔSUL 或 ΔTLG 的中位数与组织病理学反应之间无相关性。对化疗开始后 16 天或更短时间行 PET2 的 47 例患者进行的事后分析显示，ΔTLG 而非 ΔSUL 与组织病理学反应相关（P=0.009）。ΔTLG 的最佳截断值为 66%或更高。
在食管腺癌和食管胃交界腺癌患者中，化疗第一周期后的 FDG-PET/CT 不能预测组织病理学反应。
