三模态治疗后术前 FDG-PET 测定的定量参数对食管鳞癌的预后价值。
Prognostic value of quantitative parameters for esophageal squamous cell carcinoma determined by preoperative FDG-PET after trimodal therapy.
机构信息
Department of Surgical Oncology, Hiroshima University, Japan.
Department of Surgical Oncology, Hiroshima University, Japan.
出版信息
Surgery. 2022 Aug;172(2):584-592. doi: 10.1016/j.surg.2022.03.034. Epub 2022 May 4.
BACKGROUND
Associations between tumor metabolic and volumetric parameters determined by preoperative F-fluorodeoxyglucose-positron emission tomography and survival in patients with esophageal squamous cell carcinoma who underwent trimodal therapy have not been fully investigated.
METHODS
We evaluated relationships between reductions in maximal standardized uptake value, metabolic tumor volume, and total lesion glycolysis in primary tumors on F-fluorodeoxyglucose-positron emission tomography images between before and after neoadjuvant chemoradiotherapy and the survival of 120 patients with esophageal squamous cell carcinoma who underwent neoadjuvant chemoradiotherapy followed by surgery.
RESULTS
The optimal cutoffs of Δ maximal standardized uptake value, Δ metabolic tumor volume, and Δ total lesion glycolysis were defined to statistically yield the largest differences in recurrence-free survival for good and poor positron emission tomography responders to neoadjuvant chemoradiotherapy (cutoffs: 70%, 85%, and 90%, respectively). These cutoff values significantly stratified overall survival (Δ maximal standardized uptake value, P = .004; Δ metabolic tumor volume, P = .001; Δ total lesion glycolysis, P < .0001). Univariate analysis showed that Δ maximal standardized uptake value (hazard ratio, 0.50; 95% confidence interval, 0.32-0.79; P = .003), Δ metabolic tumor volume (hazard ratio, 0.50; 95% confidence interval, 0.31-0.81; P = .004), and Δ total lesion glycolysis (hazard ratio, 0.37; 95% confidence interval, 0.23-0.61; P < .001) were statistically significant for recurrence-free survival. Furthermore, Δ metabolic tumor volume (hazard ratio, 0.45; 95% confidence interval, 0.27-0.76; P = .003) and Δ total lesion glycolysis (hazard ratio, 0.37; 95% confidence interval, 0.22-0.63; P < .001) were independent factors for recurrence-free survival in multivariate analyses that included preoperative and pathological factors.
CONCLUSION
Together with significant pathological prognostic factors, Δ metabolic tumor volume and Δ total lesion glycolysis were valuable for patients with esophageal squamous cell carcinoma who received trimodal therapy. Thus, preoperative F-fluorodeoxyglucose-positron emission tomography is a useful and noninvasive diagnostic tool that might facilitate tailoring optimal therapies for locally advanced esophageal squamous cell carcinoma.
背景
术前 F-氟代脱氧葡萄糖正电子发射断层扫描（PET）测定的肿瘤代谢和体积参数与接受三联疗法的食管鳞癌患者的生存之间的关系尚未得到充分研究。
方法
我们评估了 120 例接受新辅助放化疗后行手术治疗的食管鳞癌患者，在新辅助放化疗前后原发肿瘤 F-FDG-PET 图像上最大标准化摄取值、代谢肿瘤体积和总病灶糖酵解的变化与生存之间的关系。
结果
为了统计上产生新辅助放化疗对正电子发射断层扫描反应良好和不良的患者的无复发生存率的最大差异，确定了Δ最大标准化摄取值、Δ代谢肿瘤体积和Δ总病灶糖酵解的最佳截断值（截断值分别为 70%、85%和 90%）。这些截断值显著分层了总生存（Δ最大标准化摄取值，P=0.004；Δ代谢肿瘤体积，P=0.001；Δ总病灶糖酵解，P<0.0001）。单因素分析显示，Δ最大标准化摄取值（风险比，0.50；95%置信区间，0.32-0.79；P=0.003）、Δ代谢肿瘤体积（风险比，0.50；95%置信区间，0.31-0.81；P=0.004）和Δ总病灶糖酵解（风险比，0.37；95%置信区间，0.23-0.61；P<0.001）与无复发生存显著相关。此外，Δ代谢肿瘤体积（风险比，0.45；95%置信区间，0.27-0.76；P=0.003）和Δ总病灶糖酵解（风险比，0.37；95%置信区间，0.22-0.63；P<0.001）是包括术前和病理因素的多因素分析中无复发生存的独立因素。
结论
与显著的病理预后因素一起，Δ代谢肿瘤体积和Δ总病灶糖酵解对于接受三联疗法的食管鳞癌患者具有重要价值。因此，术前 F-FDG-PET 是一种有用且无创的诊断工具，可能有助于为局部晚期食管鳞癌患者制定最佳治疗方案。
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