Krishnaraju Venkata Subramanian, Kumar Rajender, Mittal Bhagwant Rai, Singh Harjeet, Aggarwal Piyush, Singh Harmandeep, Yadav Thakur Deen, Nada Ritambhra, Gupta Vikas, Gupta Rajesh
Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India.
Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India.
Nucl Med Mol Imaging. 2024 May;58(3):104-112. doi: 10.1007/s13139-024-00841-w. Epub 2024 Jan 25.
Incidental gallbladder carcinoma (IGBC) is diagnosed in post-cholecystectomy specimens for benign indications, where the role of 2-fluro-2-deoxyglucose positron emission tomography/computed tomography(FDG-PET/CT) is not clearly defined. The present study aimed to assess the benefits of staging and prognosticating with FDG-PET/CT in IGBC.
A retrospective observational study from a tertiary-care center from January 2010 to July 2020 was performed. The demographic, clinical, histopathological, and treatment-related histories were collected. FDG-PET/CT-image findings were compared with survival outcomes through telephonic follow-up. The chi-square test was used for comparing frequencies. The univariate and multivariate survival estimates were analyzed using the Kaplan-Meier analysis and the Cox-proportional hazard model, respectively. Log-rank test was used to compare the Kaplan-Meier curves.
The study included 280 postcholecystectomy participants (mean age: 52 ± 11 years; women: 227) of whom 52.1% had open surgery(146/280). Residual disease in the gallbladder fossa (54.8% vs. 36.6%, = 0.002) and liver infiltration (32.9% vs. 22.4%, = 0.05) were seen more frequently in open surgery compared to laparoscopic surgery, while anterior abdominal wall deposits were more common in laparoscopy(35.1% vs. 24%, = 0.041). FDG-PET/CT changed the management in 10% ( = 28) of patients compared to contrast-enhanced CT. The median survival was 14 months (95%CI-10.3-17.7). A higher stage of the disease on the FDG-PET/CT (loco-regional disease-HR 4.86, = 0.006; metastatic disease-HR 7.53, < 0.001) and the presence of liver infiltration (HR-1.92, = 0.003) were independent predictors of poor survival outcomes.
FDG-PET/CT detects residual and metastatic disease in patients with IGBC, enabling the institution of appropriate management and acting as a tool for prognostication of survival.
意外胆囊癌（IGBC）是在因良性指征行胆囊切除术后的标本中被诊断出来的，在此情况下，2-氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）的作用尚未明确界定。本研究旨在评估FDG-PET/CT在IGBC分期和预后评估中的益处。
对一家三级医疗中心2010年1月至2020年7月的一项回顾性观察研究进行了分析。收集了人口统计学、临床、组织病理学和治疗相关病史。通过电话随访将FDG-PET/CT图像结果与生存结局进行比较。采用卡方检验比较频率。分别使用Kaplan-Meier分析和Cox比例风险模型分析单因素和多因素生存估计值。使用对数秩检验比较Kaplan-Meier曲线。
该研究纳入了280名胆囊切除术后参与者（平均年龄：52±11岁；女性：227名），其中52.1%接受了开放手术（146/280）。与腹腔镜手术相比，开放手术中胆囊窝残留疾病（54.8%对36.6%，P = 0.002）和肝脏浸润（32.9%对22.4%，P = 0.05）更为常见，而前腹壁转移在腹腔镜手术中更为常见（35.1%对24%，P = 0.041）。与增强CT相比，FDG-PET/CT改变了10%（n = 28）患者的治疗方案。中位生存期为14个月（95%CI - 10.3 - 17.7）。FDG-PET/CT上疾病分期较高（局部区域疾病 - HR 4.86，P = 0.006；转移性疾病 - HR 7.53，P < 0.001）以及存在肝脏浸润（HR - 1.92，P = 0.003）是生存结局不良的独立预测因素。
FDG-PET/CT可检测IGBC患者的残留和转移性疾病，有助于制定适当的治疗方案，并作为生存预后评估的工具。
