Fitoussi Olivier, Roche Jean Baptiste, Riviere Julien, Wallerand Hervé, Poulain Jean Eude, Gordien Pierre, Galland Sigolène, Henriques Bénédicte, Dupin Camille, Vincent Muriel, Kuratle Thomas, Saffarini Mo, Ramos-Pascual Sonia
Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.
Clinique St Augustin, Bordeaux, France.
Urol Int. 2023;107(3):239-245. doi: 10.1159/000528524. Epub 2023 Jan 19.
The aim of the study was to confirm the diagnostic accuracy of a second FDG-PET/CT following neoadjuvant or induction chemotherapy (NAIC) prior to radical cystectomy for patients with localized muscle-invasive bladder cancer (MIBC).
Retrospective review of 62 consecutive patients with MIBC, that had a first FDG-PET/CT between April 2016 and September 2021. Patients then underwent NAIC, followed by a second FDG-PET/CT and radical cystectomy. Patients with no hypermetabolism in the bladder and lymph nodes on the second FDG-PET/CT were considered metabolic complete responders, while patients with no evidence of residual disease on histopathology were considered pathologic complete responders. The accuracy of the second FDG-PET/CT to distinguish complete responders from patients with residual disease was calculated, with histopathology as gold standard.
Of 62 patients, 1 was lost to follow-up, 5 died before radical cystectomy, 5 had delay >2 months between the second FDG-PET/CT and radical cystectomy, and 6 did not undergo radical cystectomy and instead underwent alternative treatment. The study cohort comprised 45 patients, 39 males and 6 females, with an age of 66 ± 6 years. In comparison to histopathology, FDG-PET/CT provided (i) sensitivity of 95% and specificity of 42%, for the overall disease; (ii) sensitivity of 100% and specificity of 36%, for the primary tumor only; and (iii) sensitivity of 97% and specificity of 30%, for the lymph nodes only.
FDG-PET/CT has over 95% sensitivity for distinguishing complete responders from patients with residual disease. Thus, FDG-PET/CT can be used for early response evaluation following NAIC to identify patients that did not completely respond to chemotherapy and may require alternative treatment pathways.
本研究的目的是确认对于局限性肌层浸润性膀胱癌（MIBC）患者，在根治性膀胱切除术之前进行新辅助或诱导化疗（NAIC）后，第二次氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）的诊断准确性。
回顾性分析2016年4月至2021年9月期间连续62例接受首次FDG-PET/CT检查的MIBC患者。患者随后接受NAIC，接着进行第二次FDG-PET/CT检查和根治性膀胱切除术。第二次FDG-PET/CT检查时膀胱和淋巴结无高代谢的患者被视为代谢完全缓解者，而组织病理学检查无残留疾病证据的患者被视为病理完全缓解者。以组织病理学为金标准，计算第二次FDG-PET/CT区分完全缓解者与残留疾病患者的准确性。
62例患者中，1例失访，5例在根治性膀胱切除术之前死亡，5例在第二次FDG-PET/CT检查和根治性膀胱切除术之间延迟>2个月，6例未接受根治性膀胱切除术而是接受了替代治疗。研究队列包括45例患者，其中男性39例，女性6例，年龄为66±6岁。与组织病理学相比，FDG-PET/CT对于整体疾病的敏感性为95%，特异性为42%；仅对于原发性肿瘤的敏感性为100%，特异性为36%；仅对于淋巴结的敏感性为97%，特异性为30%。
FDG-PET/CT区分完全缓解者与残留疾病患者的敏感性超过95%。因此，FDG-PET/CT可用于NAIC后的早期反应评估，以识别对化疗未完全反应且可能需要替代治疗途径的患者。
