Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Eur J Nucl Med Mol Imaging. 2018 Sep;45(10):1742-1751. doi: 10.1007/s00259-018-4011-6. Epub 2018 Apr 16.
During neoadjuvant chemoradiotherapy for oesophageal cancer, or in the interval prior to surgery, some patients develop systemic metastasis. This study aimed to evaluate the diagnostic performance of F-FDG PET/CT for the detection of interval metastasis and to identify predictors of interval metastases in a large cohort of oesophageal cancer patients.
In total, 783 consecutive patients with potentially resectable oesophageal cancer who underwent chemoradiotherapy and pre- and post-treatment F-FDG PET/CT between 2006 and 2015 were analyzed from a prospectively maintained database. Diagnostic accuracy measures were calculated on a per-patient basis using histological verification or clinical follow-up as a reference standard. Multivariable logistic regression analysis was performed to determine pre-treatment predictors of interval metastasis. A prediction score was developed to predict the probability of interval metastasis.
Of 783 patients that underwent F-FDG PET/CT restaging, 65 (8.3%) were found to have interval metastasis and 44 (5.6%) were deemed to have false positive lesions. The resulting sensitivity and specificity was 74.7% (95% CI: 64.3-83.4%) and 93.7% (95% CI: 91.6-95.4%), respectively. Multivariable analysis revealed that tumor length, cN status, squamous cell tumor histology, and baseline SUV were associated with interval metastasis. Based on these criteria, a prediction score was developed with an optimism adjusted C-index of 0.67 that demonstrated accurate calibration.
F-FDG PET/CT restaging detects distant interval metastases in 8.3% of patients after chemoradiotherapy for oesophageal cancer. The provided prediction score may stratify risk of developing interval metastasis, and could be used to prioritize additional restaging modalities for patients most likely to benefit.
在食管癌新辅助放化疗期间或手术前的间隔期，一些患者会发生全身转移。本研究旨在评估 F-FDG PET/CT 检测间隔转移的诊断性能，并在一个大型食管癌患者队列中确定间隔转移的预测因素。
本研究从 2006 年至 2015 年期间接受新辅助放化疗和治疗前后 F-FDG PET/CT 的 783 例潜在可切除食管癌患者的前瞻性数据库中进行了分析。采用组织学验证或临床随访作为参考标准，对每位患者进行基于个体的诊断准确性测量。采用多变量逻辑回归分析确定间隔转移的预测因素。开发了一个预测评分来预测间隔转移的概率。
在 783 例接受 F-FDG PET/CT 分期的患者中，有 65 例（8.3%）发现有间隔转移，44 例（5.6%）被认为有假阳性病变。其敏感性和特异性分别为 74.7%（95%CI：64.3-83.4%）和 93.7%（95%CI：91.6-95.4%）。多变量分析显示肿瘤长度、cN 状态、鳞状细胞肿瘤组织学和基线 SUV 与间隔转移相关。基于这些标准，开发了一个预测评分，其优化调整后的 C 指数为 0.67，表现出准确的校准。
F-FDG PET/CT 分期在食管癌新辅助放化疗后可检测出 8.3%的患者发生远处间隔转移。提供的预测评分可以对发生间隔转移的风险进行分层，并可用于为最有可能受益的患者优先安排其他分期方式。
