Department of Surgery, Odense University Hospital, Odense, Denmark.
OPAC, Odense Pancreas Centre, Odense University Hospital, Odense, Denmark.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zraa028.
Most patients undergo follow-up after surgery for cancers of the gastro-oesophageal junction, stomach or pancreas, but data to support which modalities to use and the frequency of investigation are limited.
Patients in the EUFURO study were randomized to either visits to the outpatient clinic at 3, 6, 9, 12, 18, and 24 months after surgery (standard), or to the addition of [18F]fluorodeoxyglucose (FDG) PET-CT and endoscopic ultrasonography (EUS) with guided fine-needle aspiration biopsy to clinical assessments (intervention). Data from the intervention arm were used to analyse the diagnostic performance of endosonography or [18F]FDG PET-CT in detecting recurrences.
During the scheduled follow-up, 42 of 89 patients developed recurrence; PET-CT and EUS in combination detected 38 of these recurrences. EUS detected 23 of the 42 patients with recurrent disease during follow-up and correctly diagnosed 17 of 19 locoregional recurrences. EUS was able to detect isolated locoregional recurrence in 11 of 13 patients. In five patients, EUS was false-positive for isolated locoregional recurrence owing to missed distant metastases. PET-CT detected locoregional recurrence in only 12 of 19 patients, and isolated locoregional recurrence in only 7 of 13. False-positive PET-CT results in 23 patients led to a total of 44 futile procedures.
Accuracy in detecting recurrences by concomitant use of PET-CT and EUS was high (90 per cent). PET-CT had moderate to high sensitivity for overall recurrence detection, but low specificity. EUS was superior to PET-CT in the detection of locoregional and isolated locoregional recurrences.
大多数接受胃食管交界部、胃或胰腺癌症手术的患者需要进行随访，但支持使用何种方式以及检查频率的数据有限。
EUFURO 研究中的患者被随机分配至术后 3、6、9、12、18 和 24 个月接受门诊随访（标准组）或在临床评估中增加[18F]氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET-CT）和内镜超声检查（EUS）联合引导下细针抽吸活检（干预组）。干预组的数据用于分析 EUS 或[18F]FDG PET-CT 在检测复发方面的诊断性能。
在计划随访期间，89 例患者中有 42 例出现复发；PET-CT 和 EUS 联合检测到其中 38 例复发。EUS 在随访期间检测到 42 例复发病例中的 23 例，并正确诊断了 19 例局部复发中的 17 例。EUS 能够检测到 13 例孤立性局部复发中的 11 例。在 5 例患者中，EUS 因遗漏远处转移而对孤立性局部复发呈假阳性。PET-CT 在 19 例局部复发患者中仅检测到 12 例，在 13 例孤立性局部复发患者中仅检测到 7 例。23 例假阳性 PET-CT 结果导致总共 44 例无效操作。
联合使用 PET-CT 和 EUS 检测复发的准确性较高（90%）。PET-CT 对总体复发检测具有中等至高度敏感性，但特异性较低。EUS 在检测局部和孤立性局部复发方面优于 PET-CT。
