Lin Youpei, Chong Huanhuan, Song Guohe, Zhang Chenhao, Dong Liangqing, Aye Ling, Liang Fei, Yang Shuaixi, Zeng Mengsu, Ding Guangyu, Zhang Shu, Shi Jieyi, Ke Aiwu, Wang Xiaoying, Zhou Jian, Fan Jia, Gao Qiang
Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Hepatobiliary Surg Nutr. 2022 Oct;11(5):684-695. doi: 10.21037/hbsn-21-25.
Intrahepatic cholangiocarcinoma (ICC) is a highly metastatic cancer. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) enables sensitive tumor and metastasis detection. Our aim is to evaluate the influence of pre-treatment PET/CT on the N- and M-staging and subsequent clinical management in ICC patients.
Between August 2010 and August 2018, 660 consecutive ICC patients, without prior anti-tumor treatments nor other malignancies, were enrolled. The diagnostic performance of PET/CT on the N- and M-staging was compared with conventional imaging, and the preoperative staging accuracy and treatment re-allocation by PET/CT were retrospectively calculated. Survival difference was compared between patients receiving PET/CT or not after propensity score matching.
Patients were divided into group A (n=291) and group B (n=369) according to whether PET/CT was performed. Among 291 patients with both PET/CT and conventional imaging for staging in group A, PET/CT showed significantly higher sensitivity (83.0% 70.5%, P=0.001), specificity (88.3% 74.9%, P<0.001) and accuracy (86.3% 73.2%, P<0.001) than conventional imaging in diagnosing regional lymph node metastasis, as well as higher sensitivity (87.8% 67.6%, P<0.001) and accuracy (93.5% 89.3%, P=0.023) in diagnosing distant metastasis. Overall, PET/CT improved the accuracy of preoperative staging from 60.1% to 71.8% (P<0.001), and modified clinical treatment strategy in 5.8% (17/291) of ICC patients, with unique roles in different tumor-node-metastasis (TNM) stages. High tumor-to-non-tumor ratio (TNR) predicted poor overall survival [hazard ratio (HR) = 2.17; 95% confidence interval (CI): 1.49-3.15; P<0.001]. Furthermore, patients performing PET/CT had longer overall survival compared with those without PET/CT (HR =0.74; 95% CI: 0.58-0.93; P=0.011) after propensity score matching.
PET/CT was valuable for diagnosing regional lymph node metastasis and distant metastasis in ICC patients, and facilitated accurate tumor staging and optimal treatment allocation.
肝内胆管癌（ICC）是一种具有高度转移性的癌症。氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）能够灵敏地检测肿瘤及转移灶。我们的目的是评估治疗前PET/CT对ICC患者N分期和M分期以及后续临床管理的影响。
2010年8月至2018年8月，连续纳入660例未曾接受过抗肿瘤治疗且无其他恶性肿瘤的ICC患者。将PET/CT对N分期和M分期的诊断性能与传统影像学进行比较，并回顾性计算PET/CT的术前分期准确性及治疗方案重新分配情况。在倾向评分匹配后，比较接受PET/CT和未接受PET/CT患者的生存差异。
根据是否进行PET/CT，患者被分为A组（n = 291）和B组（n = 369）。在A组291例同时进行PET/CT和传统影像学分期的患者中，PET/CT在诊断区域淋巴结转移方面显示出比传统影像学显著更高的敏感性（83.0%对70.5%，P = 0.001）、特异性（88.3%对74.9%，P < 0.001）和准确性（86.3%对73.2%，P < 0.001），在诊断远处转移方面也具有更高的敏感性（87.8%对67.6%，P < 0.001）和准确性（93.5%对89.3%，P = 0.023）。总体而言，PET/CT将术前分期的准确性从60.1%提高到了71.8%（P < 0.001），并在5.8%（17/291）的ICC患者中改变了临床治疗策略，在不同的肿瘤-淋巴结-转移（TNM）分期中发挥独特作用。高肿瘤与非肿瘤比值（TNR）预示总体生存率较差[风险比（HR）= 2.17；95%置信区间（CI）：1.49 - 3.15；P < 0.001]。此外，倾向评分匹配后，进行PET/CT的患者比未进行PET/CT的患者总体生存期更长（HR = 0.74；95% CI：0.58 - 0.93；P = 0.011）。
PET/CT对诊断ICC患者的区域淋巴结转移和远处转移具有重要价值，有助于准确的肿瘤分期和优化治疗方案的制定。
