糖类抗原19-9与氟-18氟脱氧葡萄糖正电子发射断层扫描在评估可切除及交界可切除胰腺导管腺癌患者新辅助治疗疗效中的差异：一项双中心研究结果
Difference between carbohydrate antigen 19-9 and fluorine-18 fluorodeoxyglucose positron emission tomography in evaluating the treatment efficacy of neoadjuvant treatment in patients with resectable and borderline resectable pancreatic ductal adenocarcinoma: Results of a dual-center study.
作者信息
Akita Hirofumi, Takahashi Hidenori, Eguchi Hidetoshi, Asukai Kei, Hasegawa Shinichiro, Wada Hiroshi, Iwagami Yoshifumi, Yamada Daisaku, Tomimaru Yoshito, Noda Takehiro, Gotoh Kunihito, Kobayashi Shogo, Doki Yuichiro, Sakon Masato
机构信息
Department of Surgery Osaka International Cancer Institute Osaka Japan.
Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan.
出版信息
Ann Gastroenterol Surg. 2020 Dec 17;5(3):381-389. doi: 10.1002/ags3.12418. eCollection 2021 May.
BACKGROUND
An accurate evaluation of neoadjuvant treatment is important to maximize the prognostic benefit of this strategy in each individual patient. The main aim of the present study is to investigate the difference between carbohydrate antigen 19-9 and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in evaluating the response to neoadjuvant treatment for resectable and borderline resectable pancreatic ductal adenocarcinoma (PDAC) patients.
METHODS
Pancreatic ductal adenocarcinoma patients with positive standard uptake values (SUV) on FDG-PET before neoadjuvant chemoradiotherapy (NACRT) were enrolled (n = 141). In all patients, CA19-9 and FDG-PET were evaluated before the initiation of and after the completion of NACRT. The statuses of CA19-9 and FDG uptake alterations during NACRT were assessed in association with survival and tumor recurrence profiles.
RESULTS
A favorable response in each CA19-9 and FDG-PET was significantly related to better survival, respectively, than the unfavorable response (44.3% vs 19.5%, < .001 and 45.8% vs 24.6%, < .001). The status of CA19-9 was significantly associated with the incidence of distant recurrence whereas the status of FDG-PET was significantly associated with the incidence of local recurrence, and only patients with a favorable response in both CA19-9 and PET statuses showed a significantly better survival than the others (5-year survival: 56% vs 24%, < .001), and those with unfavorable response in either of CA19-9 or PET status showed similar poor survival to those with unfavorable in both ( = .164).
CONCLUSION
CA19-9 and PET evaluation provided oncologically different risk assessments in terms of tumor recurrence profile, and favorable response in both CA19-9 and FDG-PET were necessary to achieve prognostic benefit from NACRT.
背景
准确评估新辅助治疗对于使该策略在每个患者中获得最大预后益处至关重要。本研究的主要目的是探讨糖类抗原19-9和氟-18氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在评估可切除和边界可切除胰腺导管腺癌（PDAC）患者新辅助治疗反应方面的差异。
方法
纳入新辅助放化疗（NACRT）前FDG-PET标准摄取值（SUV）为阳性的胰腺导管腺癌患者（n = 141）。所有患者在NACRT开始前和完成后均接受CA19-9和FDG-PET评估。评估NACRT期间CA19-9和FDG摄取变化情况，并与生存和肿瘤复发情况相关联。
结果
与不良反应相比，CA19-9和FDG-PET各自的良好反应分别与更好的生存显著相关（44.3%对19.5%，P <.001和45.8%对24.6%，P <.001）。CA19-9状态与远处复发发生率显著相关，而FDG-PET状态与局部复发发生率显著相关，只有CA19-9和PET状态均为良好反应的患者生存明显优于其他患者（5年生存率：56%对24%，P <.001），而CA19-9或PET状态中任何一个为不良反应的患者生存情况与两者均为不良反应的患者相似（P =.164）。
结论
CA19-9和PET评估在肿瘤复发方面提供了不同的肿瘤学风险评估，CA19-9和FDG-PET均有良好反应对于从NACRT中获得预后益处是必要的。
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