F-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描作为伊马替尼耐药胃肠道间质瘤的预后标志物
F-fluorodeoxyglucose positron emission tomography-computed tomography as a prognostic marker of imatinib-resistant gastrointestinal stromal tumors.
作者信息
Kawabata Kota, Takahashi Tsuyoshi, Nishida Toshirou, Kurokawa Yukinori, Yamamoto Kazuyoshi, Saito Takuro, Momose Kota, Yamashita Kotaro, Tanaka Koji, Makino Tomoki, Kawabata Ryohei, Takeno Atsushi, Nakajima Kiyokazu, Eguchi Hidetoshi, Doki Yuichiro
机构信息
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka, Japan.
出版信息
Surg Today. 2025 Mar 28. doi: 10.1007/s00595-025-03029-7.
PURPOSE
Unresectable or metastatic GISTs often develop resistance to imatinib, but the effectiveness of other drugs is limited. Thus, surgical treatment can be considered, especially for partial resistance. FDG-PET/CT is used for the diagnosis and evaluation of GISTs. We conducted this study to establish whether FDG-PET/CT findings could guide treatment decisions and predict the prognosis of patients with imatinib-resistant GISTs.
METHODS
We analyzed data retrospectively from 45 patients with imatinib-resistant GISTs that were assessed via FDG-PET/CT at our institution between 2003 and 2021. The patients were classified as having low (n = 18) or high (n = 27) SUV, with a cutoff value of 5.0.
RESULTS
The overall survival (OS) of the patients with low SUV after the diagnosis of imatinib resistance was significantly prolonged. Multivariate analysis identified SUV as an independent poor prognostic factor. In 23 patients with resected imatinib-resistant lesions, a close correlation was found between the SUV by preoperative FDG-PET/CT and the mitotic rate. A higher SUV was associated with a higher mitotic rate. Patients with a low SUV (n = 11) had significantly longer postoperative imatinib failure-free survival than those with a high SUV (n = 12).
CONCLUSIONS
FDG-PET/CT assessment and diagnosis might reveal the pathological grades of imatinib-resistant GISTs and act as a prognostic marker.
目的
不可切除或转移性胃肠道间质瘤（GIST）常对伊马替尼产生耐药性，但其他药物的疗效有限。因此，可考虑手术治疗，尤其是对于部分耐药的情况。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）用于GIST的诊断和评估。我们开展这项研究以确定FDG-PET/CT检查结果是否能指导治疗决策并预测伊马替尼耐药GIST患者的预后。
方法
我们回顾性分析了2003年至2021年间在我院通过FDG-PET/CT评估的45例伊马替尼耐药GIST患者的数据。将患者分为标准化摄取值（SUV）低（n = 18）或高（n = 27）两组，临界值为5.0。
结果
诊断伊马替尼耐药后，SUV低的患者总生存期（OS）显著延长。多因素分析确定SUV是独立的不良预后因素。在23例切除伊马替尼耐药病灶的患者中，术前FDG-PET/CT的SUV与有丝分裂率之间存在密切相关性。SUV越高，有丝分裂率越高。SUV低的患者（n = 11）术后伊马替尼无失败生存期显著长于SUV高的患者（n = 12）。
结论
FDG-PET/CT评估和诊断可能揭示伊马替尼耐药GIST的病理分级并作为预后标志物。
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