Matsumoto Takashi, Okabe Hirohisa, Yamashita Yo-Ichi, Yusa Toshihiko, Itoyama Rumi, Nakao Yosuke, Yamao Takanobu, Umzaki Naoki, Tsukamoto Masayo, Kitano Yuki, Miyata Tatsunori, Arima Kota, Nitta Hidetoshi, Hayashi Hiromitsu, Imai Katsunori, Chikamoto Akira, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
Surg Today. 2019 Jan;49(1):21-26. doi: 10.1007/s00595-018-1703-2. Epub 2018 Aug 20.
Clinical predictive markers for the malignant potential of pancreatic neuroendocrine tumors (PNETs) are limited without histological investigation. We reported previously that a loss of the regular enhancement pattern in preoperative computed tomography (CT) was correlated with the malignant tumor phenotype. This study aimed to establish whether the metabolic aspect of the tumor evaluated by fludeoxyglucose (F) positron emission tomography/computed tomography F-FDG PET/CT is associated with the tumor imaging characteristics and postoperative oncological outcome.
Among 77 patients who underwent surgery with curative intent for a PNET at our institution between 2001 and 2017, 24 who received F-FDG PET/CT before surgery were enrolled in this study. The clinical importance of the standardized uptake value (SUVmax) was investigated with regard to tumor progression and prognosis after curative surgery.
There were four (16%) patients with insulinoma. The mean tumor size was 17 mm and when the median value of the SUVmax (= 2.0) was measured as the cut-off value, the SUVmax ≥ 2.0 group (n = 12) was associated with large tumor size (p = 0.021), high tumor grade (p = 0.015), and irregular pattern on CT (p = 0.0055). The SUVmax was not correlated with age, gender, whether the tumor was functioning or non-functioning, or lymph node metastasis. The SUVmax ≥ 2.0 group had significantly poorer disease-free survival (median, 3.5 vs 16.2 months; p = 0.023) and poorer overall survival (median, 8.8 vs 16.2 months; p = 0.042).
An SUVmax ≥ 2.0 on F-FDG PET/CT might be associated with higher malignant potential of PNETs.
在缺乏组织学检查的情况下，胰腺神经内分泌肿瘤（PNETs）恶性潜能的临床预测标志物有限。我们之前报道过，术前计算机断层扫描（CT）中常规强化模式的缺失与恶性肿瘤表型相关。本研究旨在确定通过氟脱氧葡萄糖（F）正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）评估的肿瘤代谢情况是否与肿瘤影像学特征及术后肿瘤学结局相关。
2001年至2017年间，在我们机构接受了根治性手术的77例PNET患者中，24例术前接受了F-FDG PET/CT检查的患者被纳入本研究。研究了标准化摄取值（SUVmax）对根治性手术后肿瘤进展和预后的临床重要性。
有4例（16%）胰岛素瘤患者。肿瘤平均大小为17毫米，以SUVmax的中位数（=2.0）作为截断值时，SUVmax≥2.0组（n=12）与肿瘤较大（p=0.021）、肿瘤分级高（p=0.015）及CT上的不规则模式（p=0.0055）相关。SUVmax与年龄、性别、肿瘤是否具有功能性或无功能性以及淋巴结转移无关。SUVmax≥2.0组的无病生存期明显较差（中位数，3.5个月对16.2个月；p=0.023），总生存期也较差（中位数，8.8个月对16.2个月；p=0.042）。
F-FDG PET/CT上SUVmax≥2.0可能与PNETs的更高恶性潜能相关。
