Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
Eur J Nucl Med Mol Imaging. 2022 Oct;49(12):4241-4251. doi: 10.1007/s00259-022-05872-z. Epub 2022 Jun 23.
Accurate assessment of residual disease of tumor and lymph nodes after neoadjuvant immunochemotherapy is crucial in the active surveillance for patients with pathological complete response (pCR) and the optimal extent of lymphadenectomy for patients with non-pCR. This post hoc analysis aimed to evaluate the performance of F-FDG PET/CT to predict the pathological response to neoadjuvant immunochemotherapy for esophageal squamous cell carcinoma (ESCC).
Fifty-eight resectable ESCC patients received two cycles of camrelizumab in combination with chemotherapy and were enrolled in the final analysis. The F-FDG PET/CT scans were acquired at baseline (scan-1) and after immunochemotherapy but prior to surgery (scan-2). Maximum standardized uptake value (SUV), mean standardized uptake value (SUV), tumor-to-blood pool SUV ratio (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated for their association with the pathological response to immunochemotherapy.
Nineteen patients (32.8%, 19/58) had pCR and thirty-nine patients (67.2%, 39/58) had non-pCR after two doses of camrelizumab and chemotherapy. At scan-2, the SUV, SUV, SUV, TLG, and MTV were significantly lower in pCR than in non-pCR patients. Decrease in TLG and MTV between scan-2 and scan-1 of the same patient was significantly higher in the pCR than in the non-pCR group. In the receiver operating characteristic curve analysis, SUV, SUV, SUV, TLG, and MTV in scan-2 showed excellent predictive value for the pCR of primary tumors. Furthermore, SUV in scan-2 were higher in positive lymph nodes than in negative ones, suggesting a high negative predictive ability (98.6%) with a cut-off value at 1.4.
The parameters of F-FDG PET/CT have the excellent performance for predicting pCR after the combined neoadjuvant immunochemotherapy in resectable ESCC.
ChiCTR2000028900. Registered on January 6, 2020.
准确评估新辅助免疫化疗后肿瘤和淋巴结的残留疾病对于病理完全缓解（pCR）患者的主动监测以及非 pCR 患者的最佳淋巴结清扫范围至关重要。本回顾性分析旨在评估 F-FDG PET/CT 预测食管鳞癌（ESCC）新辅助免疫化疗病理反应的性能。
58 例可切除 ESCC 患者接受两周期卡瑞利珠单抗联合化疗，并纳入最终分析。在基线（扫描 1）和免疫化疗后但手术前（扫描 2）采集 F-FDG PET/CT 扫描。评估最大标准化摄取值（SUV）、平均标准化摄取值（SUV）、肿瘤与血池 SUV 比值（SUV）、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）与免疫化疗病理反应的相关性。
19 例（32.8%，19/58）患者在接受两周期卡瑞利珠单抗和化疗后达到 pCR，39 例（67.2%，39/58）患者达到非 pCR。在扫描 2 时，pCR 患者的 SUV、SUV、SUV、TLG 和 MTV 均显著低于非 pCR 患者。同一患者扫描 2 与扫描 1 之间 TLG 和 MTV 的下降在 pCR 组中明显高于非 pCR 组。在受试者工作特征曲线分析中，扫描 2 中的 SUV、SUV、SUV、TLG 和 MTV 对原发肿瘤的 pCR 具有优异的预测价值。此外，扫描 2 中阳性淋巴结的 SUV 高于阴性淋巴结，提示截断值为 1.4 时具有高阴性预测能力（98.6%）。
F-FDG PET/CT 各参数对可切除 ESCC 新辅助免疫化疗后 pCR 具有优异的预测性能。
ChiCTR2000028900. 于 2020 年 1 月 6 日注册。
