18F-FDG PET/CT 作为阴茎癌的预后因素。
F-FDG PET/CT as a prognostic factor in penile cancer.
机构信息
Urology Section, Mario Penna Institute, Belo Horizonte, Brazil.
Pathology and Forensic Department, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
出版信息
Eur J Nucl Med Mol Imaging. 2019 Apr;46(4):855-863. doi: 10.1007/s00259-018-4128-7. Epub 2018 Aug 24.
PURPOSE
Penile cancer (PC) is a rare neoplasm with an aggressive behavior and variable prognosis. Lymph node (LN) involvement and pathological features of the primary lesion have been proven to be the most important survival factors. Positron emission tomography/computed tomography with fluorodeoxyglucose labelled with fluorine-18 (F-FDG PET/CT) provides information on tumor staging and works as a prognostic factor, with promising results in other carcinomas. The aim of the present study is to evaluate PET/CT as a prognostic factor in PC.
METHODS
Fifty-five patients (mean age 56.6 y) diagnosed with penile squamous cell carcinoma were prospectively evaluated from 2012 to 2014. All subjects underwent F-FDG PET/CT before treatment and were regularly followed after surgery.
RESULTS
Out of the 53 patients selected, 17 (32.1%) had localized disease (cT1-2) and 24 (45.3%) had palpable nodes (cN+). Partial penile amputation was performed in 38 patients (71.7%) and inguinal lymphadenectomy (LND) in 30 (56.6%). From the LND group, 16 (53.3%) presented with positive neoplastic cells (pN+). Patients with more aggressive disease had a significantly (p = 0.019) higher F-FDG tumor uptake (pSUV), while inguinal LN uptake (nSUV) was able to recognize metastatic LN (p = 0.039). Some pathological prognostic features, when presented, have shown significant changes in pSUV values. Receiver operating characteristic (ROC) curves were performed and specific cutoff values of pSUV were evaluated to determine sensitivity and specificity. Regarding regional LNs, PET/CT presented a 76.2% accuracy in cN+ patients. After a 39-month follow up, pSUV of 16.6 (p = 0.0001) and nSUV of 6.5 (p = 0.019) were established as the ideal values to predict cancer-specific survival. The multivariate analysis confirmed nSUV as a predictor for LN metastasis (p = 0.043) and pSUV as a mean to estimate survival rate (p = 0.05).
CONCLUSION
This study showed promising results on the use of F-FDG PET/CT as a prognostic tool for PC, using specific cutoff values of pSUV and nSUV.
目的
阴茎癌（PC）是一种罕见的具有侵袭性和可变预后的肿瘤。淋巴结（LN）受累和原发性病变的病理特征已被证明是最重要的生存因素。氟代脱氧葡萄糖（F-FDG）标记的正电子发射断层扫描/计算机断层扫描（PET/CT）提供了肿瘤分期的信息，并作为一种预后因素，在其他癌症中显示出有前途的结果。本研究旨在评估 PET/CT 在 PC 中的预后价值。
方法
从 2012 年至 2014 年，前瞻性评估了 55 例诊断为阴茎鳞状细胞癌的患者（平均年龄 56.6 岁）。所有患者在治疗前均接受 F-FDG PET/CT 检查，并在手术后定期随访。
结果
在 53 例入选患者中，17 例（32.1%）为局限性疾病（cT1-2），24 例（45.3%）为可触及淋巴结（cN+）。38 例患者行部分阴茎切除术（71.7%），30 例行腹股沟淋巴结清扫术（LND）（56.6%）。在 LND 组中，16 例（53.3%）有阳性肿瘤细胞（pN+）。侵袭性疾病患者的 F-FDG 肿瘤摄取（pSUV）明显升高（p=0.019），而腹股沟淋巴结摄取（nSUV）可识别转移性淋巴结（p=0.039）。一些病理预后特征的出现，pSUV 值也发生了显著变化。进行了受试者工作特征（ROC）曲线分析，并评估了 pSUV 的特定截断值，以确定敏感性和特异性。对于区域淋巴结，PET/CT 在 cN+患者中的准确性为 76.2%。在 39 个月的随访后，确定 pSUV 值为 16.6（p=0.0001）和 nSUV 值为 6.5（p=0.019）为预测癌症特异性生存的理想值。多变量分析证实 nSUV 是 LN 转移的预测因子（p=0.043），pSUV 是估计生存率的指标（p=0.05）。
结论
本研究显示，使用特定的 pSUV 和 nSUV 截断值，F-FDG PET/CT 作为 PC 的预后工具具有良好的应用前景。
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