Einerhand Sarah M H, Voskuilen Charlotte S, van de Putte Elies E Fransen, Donswijk Maarten L, Bruining Annemarie, van der Heijden Michiel S, Mertens Laura S, Hendricksen Kees, Vegt Erik, van Rhijn Bas W G
Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, TheNetherlands.
Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Bladder Cancer. 2023 Mar 31;9(1):49-57. doi: 10.3233/BLC-220036. eCollection 2023.
Neoadjuvant/induction chemotherapy (NAIC) improves survival in patients with muscle-invasive bladder carcinoma (MIBC). On-treatment response assessment may aid in decisions to continue or cease NAIC.
We investigated whether F-fluoro-2-deoxy-D-glucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) could predict response to NAIC and compared to contrast-enhanced Computed Tomography (CECT).
We prospectively included 83 patients treated for MIBC (i.e. high-risk cT2-4N0M0 or cT1-4N+M0-1a) between 2014 and 2018. Response to NAIC was assessed after 2-3 cycles with FDG-PET/CT (Peter-Mac and EORTC criteria) and CECT (RECIST1.1 criteria). We assessed prediction of complete pathological response (pCR; ypT0N0), complete pathological down-staging (pCD;≤ypT1N0), any down-staging from baseline (ypTN < cTN) and progression (inoperable tumor/ypN+/M+). The reference standard was histopathological assessment or clinical follow-up. Sensitivity, specificity, and accuracy were calculated.
Pathological response rates were 21% for pCR, 29% for pCD, and 10% progressed. All patients underwent FDG-PET/CT and 61 patients also underwent CECT (73%). Accuracy of FDG-PET/CT for prediction of pCR, pCD, and progression were 73%, 48%, and 73%, respectively. Accuracy of CECT for prediction of pCR, pCD, and progression were 78%, 65%, and 67%, respectively. Specificity of CECT was significantly higher than FDG-PET/CT for prediction of pCD and any down-staging ( = 0.007 and = 0.022). In all other analyses, no significant differences between FDG-PET/CT and CECT were found.
Routine FDG-PET/CT has insufficient predictive power to aid in response assessment compared to CECT.
新辅助/诱导化疗（NAIC）可提高肌层浸润性膀胱癌（MIBC）患者的生存率。治疗期间的反应评估可能有助于决定是否继续或停止NAIC。
我们研究了F-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）是否能够预测对NAIC的反应，并与对比增强计算机断层扫描（CECT）进行比较。
我们前瞻性纳入了2014年至2018年间接受MIBC治疗的83例患者（即高危cT2-4N0M0或cT1-4N+M0-1a）。在2-3个周期后，采用FDG-PET/CT（彼得-麦克和欧洲癌症研究与治疗组织标准）和CECT（RECIST1.1标准）评估对NAIC的反应。我们评估了完全病理缓解（pCR；ypT0N0）、完全病理降期（pCD；≤ypT1N0）、相对于基线的任何降期（ypTN＜cTN）和进展（无法手术切除的肿瘤/ypN+/M+）的预测情况。参考标准为组织病理学评估或临床随访。计算敏感性、特异性和准确性。
pCR的病理缓解率为21%，pCD为29%，10%病情进展。所有患者均接受了FDG-PET/CT检查，61例患者还接受了CECT检查（73%）。FDG-PET/CT预测pCR、pCD和进展的准确性分别为73%、48%和73%。CECT预测pCR、pCD和进展的准确性分别为78%、65%和67%。在预测pCD和任何降期方面，CECT的特异性显著高于FDG-PET/CT（P = 0.007和P = 0.022）。在所有其他分析中，未发现FDG-PET/CT和CECT之间存在显著差异。
与CECT相比，常规FDG-PET/CT在辅助反应评估方面的预测能力不足。
