Yoh Tomoaki, Seo Satoru, Morino Koshiro, Fuji Hiroaki, Ikeno Yoshinobu, Ishii Takamichi, Taura Kojiro, Nakamoto Yuji, Higashi Tatsuya, Kaido Toshimi, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan.
World J Surg. 2019 May;43(5):1323-1331. doi: 10.1007/s00268-019-04917-z.
We previously reported that tumor standardized uptake value (SUVmax) by F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) was a potential predictor in patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC). However, the prognostic value of SUVmax in the era of multidisciplinary strategy has remained unclear. The aim of this study was to reappraise the prognostic value of tumor SUVmax in patients undergoing surgery for ICC.
Data from 82 consecutive ICC patients, who underwent F-FDG-PET/CT and subsequent surgery between 2006 and 2017, were retrieved from a prospectively maintained institutional database. Adjuvant strategy was administrated during this study period in our center.
Tumor SUVmax was associated with tumor size (p = 0.002) and tumor number (p = 0.005), but not associated with T and N stage classified by American Joint Committee on Cancer-classification system, and other tumor factors. According to the tumor SUVmax cut-off values of 8.0 based on the minimum p value approach, actuarial 5-year overall survival (OS) rates in patients undergoing upfront surgery for ICC were significantly stratified at 54.7% versus 26.0% (low vs. high tumor SUVmax group, p = 0.008). The actuarial 3-year disease-free survival (DFS) rates were also significantly stratified at 41.0% versus 18.3% (p < 0.001). Multivariate Cox regression analyses revealed that tumor SUVmax retained its significance on OS (p = 0.039) as well as DFS (p < 0.001).
Even in the era of multidisciplinary strategy, high tumor SUVmax still represents poor prognosis in patients undergoing surgery for ICC. These patients, therefore, would probably be required more effective strategies.
我们之前报道过，F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）测得的肿瘤标准化摄取值（SUVmax）是肝内胆管癌（ICC）手术患者的一个潜在预测指标。然而，在多学科治疗策略时代，SUVmax的预后价值仍不明确。本研究的目的是重新评估肿瘤SUVmax在ICC手术患者中的预后价值。
从一个前瞻性维护的机构数据库中检索了2006年至2017年间连续82例接受F-FDG-PET/CT检查及后续手术的ICC患者的数据。本研究期间，我们中心采用了辅助治疗策略。
肿瘤SUVmax与肿瘤大小（p = 0.002）和肿瘤数量（p = 0.005）相关，但与美国癌症联合委员会分类系统所分类的T和N分期以及其他肿瘤因素无关。根据基于最小p值法得出的肿瘤SUVmax临界值8.0，接受ICC初次手术患者的精算5年总生存率（OS）在低肿瘤SUVmax组与高肿瘤SUVmax组之间有显著分层，分别为54.7%和26.0%（p = 0.008）。精算3年无病生存率（DFS）也有显著分层，分别为41.0%和18.3%（p < 0.001）。多变量Cox回归分析显示，肿瘤SUVmax在OS（p = 0.039）和DFS（p < 0.001）方面仍具有显著性。
即使在多学科治疗策略时代，高肿瘤SUVmax在接受ICC手术的患者中仍代表预后不良。因此，这些患者可能需要更有效的治疗策略。
