Palomar Muñoz Azahara, Cordero García José Manuel, Talavera Rubio Mª Del Prado, García Vicente Ana Mª, Pena Pardo Francisco José, Jiménez Londoño Germán Andrés, Soriano Castrejón Ángel, Aranda Aguilar Enrique
Nuclear Medicine-PET IDI Department, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona).
Nuclear Medicine Department, Hospital General Universitario de Ciudad Real, Ciudad Real.
Medicine (Baltimore). 2018 Apr;97(17):e0098. doi: 10.1097/MD.0000000000010098.
To assess the diagnostic accuracy of CA125, its kinetic values and positron emission tomography/computed tomography with 2-deoxy-2-[F]fluoro-D-glucose ([F]FDG-PET/CT), in relation with tumor characteristics for suspected recurrence of ovarian cancer. To evaluate the performance of CA125-related parameters as a selection criteria to perform a [F]FDG-PET/CT.A retrospective analysis of 69 [F]FDG-PET/CT for suspected recurrence of ovarian cancer was performed. All patients had 2 measurements of CA125, before PET/CT, to calculate kinetic values, as CA125vel (CA125vel = [CA125a - CA125b]/time) and CA125dt (CA125dt = [log2 × time]/[logCA125a - CA125b]). Maximum standard uptake value (SUVmax) was calculated. The diagnostic accuracy was calculated for all the variables and the optimal cut-off value of each of them by the receiver-operating characteristics (ROC) analysis. All the tests were compared with tumor characteristics and clinical-radiological evolution during follow-up of at least 6 months.Fifty-five cases were diagnosed of recurrence (11 with CA125 <35 U/mL), while 14 showed no disease (11 with CA125 < 35 U/mL). All of them were correctly cataloged by PET/CT. CA125, CA125vel, and SUVmax showed higher levels in recurrent patients (mean 129.54 U/mL, 24.58 U/mL per mo, and 8.69 g/mL, respectively) than in nonrecurrent (mean 20.35 U/mL, 0.60 U/mL per mo, and 0.64 g/mL, respectively). No statistical differences in CA125dt were found. Patients with recurrence of high-grade serous carcinoma (HGSC) showed higher CA125 and CA125vel, without differences in the rest of subtypes and International Federation of Gynecology and Obstetrics stages. The ROC analyses for CA125, CA125vel, and CA125dt showed an area under the curve (AUC) of 0.873 (95% confidence interval [CI] 0.77-0.969), 0.903 (95% CI 0.813-0.994), and 0.727 (95% CI 0.542-0.913), respectively, with an optimal cut-off point of 23.95 U/mL, 4.49 U/mL per mo, and 3.36 months, respectively, while for the SUVmax the AUC was of 0.982 (95% CI 0.948-1.000), and the cut-off point of 2. Multivariate regression analysis identified CA125 and CA125vel as predictors of recurrence.[F]FDG-PET/CT is more accurate than the parameters obtained from the CA125 to detect early recurrence. CA125vel is the most suitable parameter, mainly in HGSC. Levels of CA125vel ≥ 4.49 U/mL per mo facilitate earlier detection by the execution of a [F]FDG-PET/CT. The calculation of these parameters is independent of tumor stage at diagnosis.
为评估糖类抗原125（CA125）、其动力学值以及2-脱氧-2-[F]氟-D-葡萄糖正电子发射断层扫描/计算机断层扫描（[F]FDG-PET/CT）对疑似卵巢癌复发的诊断准确性，并评估CA125相关参数作为进行[F]FDG-PET/CT选择标准的性能。对69例疑似卵巢癌复发的[F]FDG-PET/CT进行回顾性分析。所有患者在PET/CT检查前均进行了2次CA125测量，以计算动力学值，即CA125速度（CA125vel = [CA125a - CA125b]/时间）和CA125倍增时间（CA125dt = [log2×时间]/[logCA125a - CA125b]）。计算最大标准摄取值（SUVmax）。通过受试者操作特征（ROC）分析计算所有变量的诊断准确性及其各自的最佳截断值。所有检查均与肿瘤特征以及至少6个月随访期间的临床-放射学演变进行比较。55例被诊断为复发（11例CA125＜35 U/mL），14例无疾病（11例CA125＜35 U/mL）。PET/CT对所有病例的分类均正确。复发患者的CA125、CA125vel和SUVmax水平（分别为平均129.54 U/mL、每月24.58 U/mL和8.69 g/mL）高于未复发患者（分别为平均20.35 U/mL、每月0.60 U/mL和0.64 g/mL）。CA125dt未发现统计学差异。高级别浆液性癌（HGSC）复发患者的CA125和CA125vel较高，其他亚型和国际妇产科联盟分期则无差异。CA125、CA125vel和CA125dt的ROC分析显示曲线下面积（AUC）分别为0.873（95%置信区间[CI] 0.77 - 0.969）、0.903（95% CI 0.813 - 0.994）和0.727（95% CI 0.542 - 0.913），最佳截断点分别为23.95 U/mL、每月4.49 U/mL和3.36个月，而SUVmax的AUC为0.982（95% CI 0.948 - 1.000），截断点为2。多因素回归分析确定CA125和CA125vel为复发的预测指标。[F]FDG-PET/CT比从CA125获得的参数更准确地检测早期复发。CA125vel是最合适的参数，主要适用于HGSC。CA125vel≥每月4.49 U/mL有助于通过进行[F]FDG-PET/CT更早地检测复发。这些参数的计算与诊断时的肿瘤分期无关。
