[F]氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FMISO PET/CT）作为胰腺癌患者术前的预后因素
[F]FMISO PET/CT as a preoperative prognostic factor in patients with pancreatic cancer.
作者信息
Yamane Tomohiko, Aikawa Masayasu, Yasuda Masanori, Fukushima Kenji, Seto Akira, Okamoto Koujun, Koyama Isamu, Kuji Ichiei
机构信息
Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1108, Japan.
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1108, Japan.
出版信息
EJNMMI Res. 2019 May 9;9(1):39. doi: 10.1186/s13550-019-0507-8.
BACKGROUND
While [F]fluoromisonidazole (FMISO), a representative PET tracer to detect hypoxia, is reported to be able to prospect the prognosis after treatment for various types of cancers, the relation is unclear for pancreatic cancer. The aim of this study is to assess the feasibility of [F]FMISO PET/CT as a preoperative prognostic factor in patients with pancreatic cancer.
METHODS
Patients with pancreatic cancer who had been initially planned for surgery received [F]FMISO PET/CT. Peak standardized uptake value (SUV) of the pancreatic tumor was divided by SUVpeak of the aorta, and tumor blood ratio using SUVpeak (TBRpeak) was calculated. After preoperative examination, surgeons finally decided the operability of the patients. TBRpeak was compared with hypoxia-inducible factor (HIF)-1α immunohistochemistry when the tissues were available. Furthermore, correlation of TBRpeak with the recurrence-free survival and the overall survival were evaluated by Kaplan-Meyer methods.
RESULTS
We analyzed 25 patients with pancreatic adenocarcinoma (11 women and 14 men, median age, 73 years; range, 58-81 years), and observed for 39-1101 days (median, 369 days). Nine cases (36.0%) were identified as visually positive of pancreatic cancer on [F]FMISO PET/CT images. TBRpeak of the negative cases was significantly lower than that of the positive cases (median 1.08, interquartile range (IQR) 1.02-1.15 vs median 1.50, IQR 1.25-1.73, p < 0.001), and the cutoff TBRpeak was calculated as 1.24. Five patients were finally considered inoperable. There was no significant difference in TBRpeak of inoperable and operable patients (median 1.48, IQR 1.06-1.98 vs median 1.12, IQR 1.05-1.21, p = 0.10). There was no significant difference between TBRpeak and HIF-1α expression (p = 0.22). The patients were dichotomized by the TBRpeak cutoff, and the higher group showed significantly shorter recurrence-free survival than the other (median 218 vs 441 days, p = 0.002). As for overall survival of 20 cases of operated patients, the higher TBRpeak group showed significantly shorter overall survival than the other (median survival, 415 vs > 1000 days, p = 0.04).
CONCLUSIONS
[F]FMISO PET/CT has the possibility to be a preoperative prognostic factor in patients with pancreatic cancer.
背景
虽然[F]氟米索硝唑（FMISO）作为一种用于检测缺氧的代表性正电子发射断层显像（PET）示踪剂，据报道能够预测各种类型癌症治疗后的预后，但胰腺癌的这种关系尚不清楚。本研究的目的是评估[F]FMISO PET/CT作为胰腺癌患者术前预后因素的可行性。
方法
最初计划进行手术的胰腺癌患者接受了[F]FMISO PET/CT检查。将胰腺肿瘤的峰值标准化摄取值（SUV）除以主动脉的SUV峰值，计算使用SUV峰值的肿瘤血比（TBRpeak）。术前检查后，外科医生最终确定患者的可手术性。当有组织可用时，将TBRpeak与缺氧诱导因子（HIF）-1α免疫组化结果进行比较。此外，采用Kaplan-Meier方法评估TBRpeak与无复发生存率和总生存率的相关性。
结果
我们分析了25例胰腺腺癌患者（11例女性和14例男性，中位年龄73岁；范围58 - 81岁），观察时间为39 - 1101天（中位时间369天）。9例（36.0%）在[F]FMISO PET/CT图像上被判定为胰腺癌视觉阳性。阴性病例的TBRpeak显著低于阳性病例（中位数1.08，四分位间距（IQR）1.02 - 1.15，而中位数1.50，IQR 1.25 - 1.73，p < 0.001），TBRpeak的截断值计算为1.24。5例患者最终被认为无法手术。无法手术和可手术患者的TBRpeak无显著差异（中位数1.48，IQR 1.06 - 1.98，与中位数1.12，IQR 1.05 - 1.21，p = 0.10）。TBRpeak与HIF-1α表达之间无显著差异（p = 0.22）。根据TBRpeak截断值将患者分为两组，较高组的无复发生存期明显短于另一组（中位数218天对441天，p = 0.002）。对于20例接受手术患者的总生存期，TBRpeak较高组的总生存期明显短于另一组（中位生存期，415天对>1000天，p = 0.04）。
结论
[F]FMISO PET/CT有可能成为胰腺癌患者的术前预后因素。
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