Huang Rong, Hu Yuxiao, Zhang Yun
Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
Clin Med Insights Oncol. 2024 Apr 22;18:11795549241245691. doi: 10.1177/11795549241245691. eCollection 2024.
Cancer of unknown primary (CUP) is difficult to diagnose and classify clinically, and the disease develops rapidly. Therefore, the primary tumor detected in patients with CUP plays a profound role in the diagnosis and treatment of patients. The search for the primary tumor of CUP is also one of the indications for 18F-fluoro-2-deoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT). Our objective was to evaluate the role of F-FDG PET/CT imaging in primary tumor detection and treatment formulation in patients with CUP.
Sixty-two patients with CUP were selected from a database consisting of 18 802 cases in the Jiangsu Cancer Hospital PET/CT center from May 18, 2016 to November 18, 2022. Clinical data and changes in treatment strategies before and after PET/CT were collected.
A total of 42 primary tumors (42/62, 67.7%) were identified by PET/CT examination. The tumor staging of patients before conventional PET/CT imaging (such as CT/magnetic resonance imaging [MRI]/US) and after PET/CT did not change in 28 patients (28/62, 45.2%), whereas for 34 patients (34/62, 54.8%), tumor staging changed. Forty-five patients (45/62, 72.6%) had not developed treatment plans before PET/CT examination, but treatment plans were clarified after PET/CT examination. Thirteen patients (13/62, 21.0%) underwent changes in treatments before and after PET/CT examination. Among the 20 patients (20/62, 32.3%) whose primary tumors were not detected, 16 patients (16/20, 80.0%) had no treatment plans before PET/CT and the treatment plans were defined after PET/CT, 3 patients (3/20, 15.0%) changed the treatment plans before and after PET/CT, and 1 patient (1/20, 5.0%) did not change the treatment plan.
The F-FDG PET/CT plays an important role in the detection and staging of primary tumors in patients with CUP. The PET/CT findings can not only help clinicians develop appropriate treatment plans for patients with CUP but also serve as an effective approach to improve real-life treatment strategies for these patients.
原发灶不明的癌症（CUP）在临床上难以诊断和分类，且疾病进展迅速。因此，CUP患者中检测到的原发肿瘤对患者的诊断和治疗起着深远的作用。寻找CUP的原发肿瘤也是18F-氟-2-脱氧葡萄糖-正电子发射断层扫描和计算机断层扫描（FDG-PET/CT）的适应证之一。我们的目的是评估F-FDG PET/CT成像在CUP患者原发肿瘤检测及治疗方案制定中的作用。
从2016年5月18日至2022年11月18日江苏省肿瘤医院PET/CT中心的18802例病例数据库中选取62例CUP患者。收集PET/CT检查前后的临床资料及治疗策略变化。
PET/CT检查共发现42例原发肿瘤（42/62，67.7%）。28例患者（28/62，45.2%）在常规PET/CT成像（如CT/磁共振成像[MRI]/超声）前和PET/CT后的肿瘤分期未改变，而34例患者（34/62，54.8%）的肿瘤分期发生了改变。45例患者（45/62，72.6%）在PET/CT检查前未制定治疗方案，但PET/CT检查后明确了治疗方案。13例患者（13/62，21.0%）在PET/CT检查前后治疗发生了改变。在20例（20/62，32.3%）未检测到原发肿瘤的患者中，16例患者（16/20，80.0%）在PET/CT前没有治疗方案，PET/CT后确定了治疗方案，3例患者（3/20，15.0%）在PET/CT前后改变了治疗方案，1例患者（1/20，5.0%）未改变治疗方案。
F-FDG PET/CT在CUP患者原发肿瘤的检测和分期中发挥着重要作用。PET/CT检查结果不仅有助于临床医生为CUP患者制定合适的治疗方案，也可作为改善这些患者实际治疗策略的有效方法。
