氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在原发性和复发性肾细胞癌中的临床应用。

Clinical utility of FDG PET/CT for primary and recurrent papillary renal cell carcinoma.

机构信息

Department of Nuclear Medicine, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.

Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China.

出版信息

Cancer Imaging. 2021 Feb 25;21(1):25. doi: 10.1186/s40644-021-00393-8.

DOI:10.1186/s40644-021-00393-8

PMID:33632314

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7908760/

Abstract

PURPOSE

Papillary renal cell carcinoma (RCC) is the second most common subtype of RCC, after clear cell RCC. This study aimed to investigate the usefulness of FDG PET/CT in primary and recurrent papillary RCC, and the role of staging FDG PET/CT in predicting survival.

METHODS

A total of 66 patients with histopathologically confirmed papillary RCC who underwent either staging or restaging FDG PET/CT scans (30 had staging scans only, 28 had restaging scans only, 8 had both) were retrospectively included in this study. The sensitivity and specificity of restaging FDG PET/CT for detecting recurrence were assessed by histopathology and/or clinical follow-up as standard reference.

RESULTS

Staging FDG PET/CT scans were performed in 38 patients, of which 31 (81.5%) showed FDG-positive primary renal lesions. The SUVmax of high-grade (WHO grade 3 and 4) papillary RCCs were significantly higher than that of low-grade (WHO grade 1 and 2) tumors (9.44 ± 6.18 vs 4.83 ± 3.19, P = 0.008). The SUVmax was not significantly different between type 1 and type 2 papillary RCCs (5.71 ± 2.88 vs. 6.99 ± 5.57, P = 0.563). Of the 38 patients, 12 developed disease progression during the follow-up period. Patients with primary tumor SUVmax> 5.85 were associated with significantly shorter progression-free survival (PFS) than those with tumor SUVmax≤5.85 (P = 0.005). Restaging FDG PET/CT scans were performed in 36 patients with suspected recurrent papillary RCCs. FDG PET/CT showed a sensitivity and specificity of 100 and 72.7% for detecting recurrent disease. Comparison of PET/CT scans with CT/MRI imaging was available in 23 patients. FDG PET/CT revealed additional findings in 11 patients, mainly including lymph node and bone metastases. FDG PET/CT findings led to change in management in 5.3% (2/38) of patients in the staging setting and 16.7 (6/36) of patients in the restaging setting.

CONCLUSIONS

FDG PET/CT had a sensitivity of 81.5% for detecting primary papillary RCC, and tumor SUVmax derived from staging FDG PET/CT was a predictor of PFS. In the restaging process of papillary RCC, FDG PET/CT was very effective for detecting recurrent disease.

摘要

目的

乳头状肾细胞癌（RCC）是继透明细胞 RCC 之后第二常见的 RCC 亚型。本研究旨在探讨 FDG PET/CT 在原发性和复发性乳头状 RCC 中的应用价值，以及分期 FDG PET/CT 在预测生存方面的作用。

方法

回顾性纳入 66 例经组织病理学证实为乳头状 RCC 且行 FDG PET/CT 分期或再分期检查的患者（30 例仅行分期检查，28 例仅行再分期检查，8 例同时行分期和再分期检查）。通过组织病理学和/或临床随访作为标准参考，评估再分期 FDG PET/CT 检测复发的敏感性和特异性。

结果

38 例患者行 FDG PET/CT 分期检查，其中 31 例（81.5%）显示 FDG 阳性原发性肾病变。高级别（WHO 分级 3 级和 4 级）乳头状 RCC 的 SUVmax 明显高于低级别（WHO 分级 1 级和 2 级）肿瘤（9.44±6.18 比 4.83±3.19，P=0.008）。1 型和 2 型乳头状 RCC 的 SUVmax 无显著差异（5.71±2.88 比 6.99±5.57，P=0.563）。在 38 例患者中，12 例在随访期间发生疾病进展。原发性肿瘤 SUVmax＞5.85 的患者与 SUVmax≤5.85 的患者相比，无进展生存期（PFS）明显更短（P=0.005）。36 例疑似复发性乳头状 RCC 患者行再分期 FDG PET/CT 检查。FDG PET/CT 对检测复发性疾病的敏感性和特异性分别为 100%和 72.7%。23 例患者可比较 PET/CT 扫描与 CT/MRI 影像学结果。FDG PET/CT 在 11 例患者中发现了额外的病变，主要包括淋巴结和骨转移。在分期检查中，FDG PET/CT 结果导致 5.3%（2/38）的患者治疗方案发生改变，在再分期检查中，导致 16.7%（6/36）的患者治疗方案发生改变。