（18）F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描中肿瘤/正常食管比值在食管鳞状细胞癌新辅助化疗后的疗效及预后分层中的应用
Tumor/normal esophagus ratio in (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for response and prognosis stratification after neoadjuvant chemotherapy for esophageal squamous cell carcinoma.
作者信息
Izumi Dasiuke, Yoshida Naoya, Watanabe Masayuki, Shiraishi Shinya, Ishimoto Takatsugu, Kosumi Keisuke, Tokunaga Ryuma, Taki Katsunobu, Higashi Takaaki, Harada Kazuto, Miyata Tatsunori, Ida Satoshi, Imamura Yu, Iwagami Shiro, Baba Yoshifumi, Sakamoto Yasuo, Miyamoto Yuji, Yamashita Yasuyuki, Baba Hideo
机构信息
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
出版信息
J Gastroenterol. 2016 Aug;51(8):788-95. doi: 10.1007/s00535-015-1150-4. Epub 2015 Dec 15.
BACKGROUND
Positron emission tomography (PET) response criteria in solid tumors were recently proposed as a standardized method for the metabolic and quantitative assessment of response to chemotherapy. However, use of these criteria is limited in many institutions because of the need for exclusive software. This study was designed to clarify whether tumor to normal esophageal (T/N) ratio on (18)F-fluorodeoxyglucose PET/computed tomography could predict response to neoadjuvant chemotherapy and stratify prognosis in patients with esophageal squamous cell carcinoma (ESCC).
METHODS
Clinicopathological data were collected for 73 patients with ESCC who received neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by curative resection. The right liver lobe and normal esophagus were utilized as reference tissues for diagnosing complete metabolic response (CMR). Statistical methods included Kaplan-Meier analysis and univariate and multivariate Cox proportional hazards regression analyses.
RESULTS
CMR was achieved in 24 patients on the basis of maximum standardized uptake value (SUVmax) and in 11 on the basis of SUVmax evaluation with T/N ratio. Although prognosis was poorer in patients who achieved CMR than partial metabolic response based on SUVmax, the responses were significantly correlated with disease-free survival (DFS) based on SUVmax evaluation with T/N ratio (P = 0.0011). Receiver operating characteristic curve analysis showed that SUVmax evaluation with T/N ratio was the best predictor of pGrade 3. Multivariate analysis showed that SUVmax evaluation with T/N ratio was an independent predictor of DFS in patients with pGrade 1 pathologic response.
CONCLUSIONS
SUVmax evaluation with T/N ratio is useful for evaluating the effects of neoadjuvant chemotherapy in patients with ESCC.
背景
实体瘤的正电子发射断层扫描（PET）反应标准最近被提出，作为化疗反应的代谢和定量评估的标准化方法。然而，由于需要专用软件，这些标准在许多机构的使用受到限制。本研究旨在阐明在（18）F-氟脱氧葡萄糖PET/计算机断层扫描上肿瘤与正常食管（T/N）比值是否能预测食管鳞状细胞癌（ESCC）患者对新辅助化疗的反应并分层预后。
方法
收集73例接受多西他赛、顺铂和5-氟尿嘧啶新辅助化疗后行根治性切除的ESCC患者的临床病理数据。将右肝叶和正常食管用作诊断完全代谢反应（CMR）的参考组织。统计方法包括Kaplan-Meier分析以及单因素和多因素Cox比例风险回归分析。
结果
基于最大标准化摄取值（SUVmax），24例患者实现了CMR，基于SUVmax评估与T/N比值，11例患者实现了CMR。尽管基于SUVmax实现CMR的患者的预后比部分代谢反应患者差，但基于SUVmax评估与T/N比值的反应与无病生存期（DFS）显著相关（P = 0.0011）。受试者工作特征曲线分析表明，SUVmax评估与T/N比值是pGrade 3的最佳预测指标。多因素分析表明，SUVmax评估与T/N比值是pGrade 1病理反应患者DFS的独立预测指标。
结论
SUVmax评估与T/N比值有助于评估ESCC患者新辅助化疗的效果。
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