18F-FDG PET/CT 是否改变潜在可切除结直肠癌肝转移的手术治疗策略？

Does F-FDG PET/CT change the surgical management of potentially resectable colorectal liver metastases?

机构信息

Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.

Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.

出版信息

Scand J Surg. 2022 Jan-Mar;111(1):14574969221083144. doi: 10.1177/14574969221083144.

DOI:10.1177/14574969221083144

PMID:35348393

Abstract

PURPOSE

Resectability assessment of patients with colorectal liver metastases is based on computed tomography and liver magnetic resonance imaging. Addition of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography has been recommended, but the impact of the added information remains unclear. The primary aim of this study was to determine how preoperative positron emission tomography/computed tomography changed management in patients with potentially resectable colorectal liver metastases. The secondary aim was to investigate whether findings on positron emission tomography/computed tomography correlated to metastatic disease in cases with extended surgery and influenced oncological outcomes.

METHODS

A retrospective observational study of the impact of adding positron emission tomography/computed tomography to conventional imaging in the surgical decision-making of colorectal liver metastases. All patients with colorectal liver metastases diagnosed by conventional imaging were included and assessed by a multidisciplinary team conference at Umeå University Hospital between June 2013 and December 2017. Eligibility criteria were all patients with potentially resectable colorectal liver metastases. Patients who underwent preoperative positron emission tomography/computed tomography in addition to conventional radiology were compared with those who underwent conventional imaging only.

RESULTS

151/220 patients underwent preoperative positron emission tomography/computed tomography. Findings on positron emission tomography/computed tomography changed the management in 10.6% of the patients. Eight patients were excluded from surgery after detection by positron emission tomography/computed tomography of extrahepatic disease. Eight patients underwent more extended surgery than initially planned due to positron emission tomography/computed tomography. Five of these positron emission tomography-positive resected sites were verified by pathology as metastatic disease. No difference in overall survival was seen following surgical resection in patients with and without a preoperative positron emission tomography/computed tomography.

CONCLUSIONS

Preoperative positron emission tomography/computed tomography resulted in a changed surgical management in 10.6% of cases in a selected cohort.

摘要

目的

结直肠癌肝转移患者的可切除性评估基于计算机断层扫描和肝脏磁共振成像。已推荐添加氟-18-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描，但添加信息的影响仍不清楚。本研究的主要目的是确定术前正电子发射断层扫描/计算机断层扫描如何改变潜在可切除结直肠癌肝转移患者的治疗方法。次要目的是研究在扩大手术中，正电子发射断层扫描/计算机断层扫描的结果与转移性疾病的相关性，以及是否影响肿瘤学结果。

方法

这是一项关于在结直肠癌肝转移的手术决策中添加正电子发射断层扫描/计算机断层扫描对常规影像影响的回顾性观察研究。所有通过常规影像学诊断为结直肠癌肝转移的患者均被纳入，并于 2013 年 6 月至 2017 年 12 月在于默奥大学医院由多学科团队会议进行评估。纳入标准为所有具有潜在可切除结直肠癌肝转移的患者。接受常规影像学和术前正电子发射断层扫描/计算机断层扫描的患者与仅接受常规影像学的患者进行比较。

结果

220 例患者中有 151 例接受了术前正电子发射断层扫描/计算机断层扫描。正电子发射断层扫描/计算机断层扫描的结果改变了 10.6%患者的治疗方案。8 例患者由于正电子发射断层扫描/计算机断层扫描检测到肝外疾病而被排除在手术之外。由于正电子发射断层扫描/计算机断层扫描，8 例患者接受了比最初计划更广泛的手术。这 8 例中，有 5 例正电子发射断层扫描阳性的切除部位经病理证实为转移性疾病。在接受手术切除的患者中，有无术前正电子发射断层扫描/计算机断层扫描的患者的总生存率无差异。