基于 F-FDG PET/CT 和 DW-MRI 的术前预测食管癌患者新辅助放化疗病理反应的前瞻性多中心研究。
Preoperative Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients With Esophageal Cancer Using F-FDG PET/CT and DW-MRI: A Prospective Multicenter Study.
机构信息
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
出版信息
Int J Radiat Oncol Biol Phys. 2020 Apr 1;106(5):998-1009. doi: 10.1016/j.ijrobp.2019.12.038. Epub 2020 Jan 25.
PURPOSE
Accurate preoperative prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in patients with esophageal cancer could enable omission of esophagectomy in patients with a pathologic complete response (pCR). This study aimed to evaluate the individual and combined value of F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (F-FDG PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) during and after nCRT to predict pathologic response in patients with esophageal cancer.
METHODS AND MATERIALS
In this multicenter prospective study, patients scheduled to receive nCRT followed by esophagectomy for esophageal cancer underwent F-FDG PET/CT and DW-MRI scanning before the start of nCRT, during nCRT, and before esophagectomy. Response to nCRT was based on histopathologic evaluation of the resection specimen. Relative changes in F-FDG PET/CT and DW-MRI parameters were compared between patients with pCR and non-pCR groups. Multivariable ridge regression analyses with bootstrapped c-indices were performed to evaluate the individual and combined value of F-FDG PET/CT and DW-MRI.
RESULTS
pCR was found in 26.1% of 69 patients. Relative changes in F-FDG PET/CT parameters after nCRT (Δ standardized uptake value [SUV]P = .016, and Δ total lesion glycolysis P = .024), as well as changes in DW-MRI parameters during nCRT (Δ apparent diffusion coefficient [ADC]P = .008) were significantly different between pCR and non-pCR. A c-statistic of 0.84 was obtained for a model with ΔADC, ΔSUV, and histology in classifying patients as pCR (versus 0.82 for ΔADC and 0.79 for ΔSUV alone).
CONCLUSIONS
Changes on F-FDG PET/CT after nCRT and early changes on DW-MRI during nCRT can help identify pCR to nCRT in esophageal cancer. Moreover, F-FDG PET/CT and DW-MRI might be of complementary value in the assessment of pCR.
目的
准确预测接受新辅助放化疗（nCRT）的食管癌患者的病理反应，有助于对病理完全缓解（pCR）患者避免行食管切除术。本研究旨在评估 nCRT 期间和结束后 F-氟代脱氧葡萄糖正电子发射断层扫描与整合计算机断层扫描（F-FDG PET/CT）和弥散加权磁共振成像（DW-MRI）在预测食管癌患者病理反应方面的单独和联合价值。
方法和材料
本多中心前瞻性研究纳入了计划接受 nCRT 治疗后行食管切除术的食管癌患者，在 nCRT 开始前、进行中以及手术前分别行 F-FDG PET/CT 和 DW-MRI 扫描。nCRT 反应基于切除标本的组织病理学评估。比较 pCR 与非 pCR 组患者的 F-FDG PET/CT 和 DW-MRI 参数的相对变化。采用 Bootstrap 法进行多变量 Ridge 回归分析，评估 F-FDG PET/CT 和 DW-MRI 的单独和联合价值。
结果
69 例患者中，pCR 发生率为 26.1%。nCRT 后 F-FDG PET/CT 参数的相对变化（Δ标准化摄取值 SUVP =.016，Δ总病灶糖酵解 P =.024），以及 nCRT 期间 DW-MRI 参数的变化（Δ表观扩散系数 ADC P =.008）在 pCR 与非 pCR 组之间存在显著差异。基于 ΔADC、ΔSUV 和组织学的模型在区分 pCR 患者方面具有 0.84 的 C 统计量（0.82 用于 ΔADC，0.79 用于 ΔSUV 单独）。
结论
nCRT 后 F-FDG PET/CT 的变化和 nCRT 期间 DW-MRI 的早期变化有助于识别食管癌患者的 nCRT 病理完全缓解。此外，F-FDG PET/CT 和 DW-MRI 在评估 pCR 方面可能具有互补价值。
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