Ann Surg：FDG-PET不能有效评价新辅助放化疗后的食管癌患者的缓解率

SUV2值与形态学缓解率及进行R0切除术可能性的关系

在完成初步的新辅助放化疗(CRT)后，通过非侵入式的评价手段对肿瘤缓解率进行判断有助于治疗决策的形成，从而筛选出可从手术治疗中获益的患者。而对于氟标记-氟脱氧葡萄糖正电子发射断层扫描(FDG-PET)能否提供相关临床的信息，目前仍存在争议。为此，法国里尔大学医院的Christophe Mariette博士等人进行了一项研究(研究登记信息：http://www.e-cancer RECF0350.)，该研究针对可切除的局部晚期食管癌患者，对患者完成新辅助放化疗(CRT)后，FDG-PET在肿瘤缓解率方面的评价作用进行了考察。这项研究结果发表于2013年3月6日在线出版的《外科学年鉴》(Annals of Surgery)杂志上。

这项前瞻性研究的招募对象为可进行手术治疗的局部晚期食管癌患者(临床分期为 T3 N0-1 M0)。完整的治疗方案包括新辅助CRT(顺铂 + 5-氟尿嘧啶/45 Gy)，6-8周后进行全胸段食管切除术治疗。在CRT开始前2周以及CRT结束4-6周时，通过形态学及FDG-PET方法进行评价。研究人员对治疗前及治疗后的瘤内FDG标准化摄取值(SUV1、SUV2、百分比变化量)进行了评价。并将这些变量与病理学缓解率、形态缓解率和生存率进行了关联。在研究者未发现出现病情转移时，在FDG-PET结果方面采用研究者盲法。

在60例患者中，有46例患者完成了全部治疗方案治疗(患者中位年龄: 60.1 岁; 腺癌: 25 例; 鳞状细胞癌: 21例)。研究人员发现，45.7%的患者得到了较大程度的病理缓解，且结局良好(P = 0.057)。新辅助CRT显著降低了瘤内FDG摄取值(P < 0.001)。病理缓解(完全或较大程度缓解)及FDG-PET结果之间并未显著关联(P > 0.280)。SUV2值与形态学缓解率及进行R0切除术可能性之间存在关联(P < 0.018; 受试者操作特性曲线分析: SUV2 阈值 = 5.5)。本研究未发现代谢成像与复发率及生存率之间存在显著关联。

研究人员最终认为，对于接受新辅助CRT继以手术治疗的局部晚期食管癌患者，FDG-PET与其病理缓解率及长期生存率之间并无有效联系。（生物谷Bioon.com）

DOI: 10.1097/SLA.0b013e31828676c4
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Ineffectiveness of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Evaluation of Tumor Response After Completion of Neoadjuvant Chemoradiation in Esophageal Cancer

Piessen G Petyt G Duhamel A Mirabel X Huglo D Mariette C

OBJECTIVE:: To evaluate the role of F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the assessment of tumor response after the completion of neoadjuvant chemoradiation (CRT) in patients with locally advanced resectable esophageal cancer. BACKGROUND:: After primary CRT, a noninvasive evaluation of the tumor response could help in the treatment decision to identify patients who may benefit from surgery. Whether FDG-PET provides clinically relevant information remains questionable. METHODS:: Operable patients with locally advanced esophageal cancer (clinically staged T3 N0-1 M0) were enrolled in this prospective study. The complete treatment plan included neoadjuvant CRT (cisplatin + 5-fluorouracil/45 Gy) followed 6 to 8 weeks later by a transthoracic en bloc esophagectomy. Morphological evaluation combined with FDG-PET was performed 2 weeks before the start of CRT and 4 to 6 weeks after the completion of CRT. Intratumoral pre- and posttreatment FDG-standardized uptake values (SUV1, SUV2, percentage change) were assessed. These variables were correlated with pathological and morphologic responses and survival. Investigators were blinded to the FDG-PET results unless they revealed metastatic disease. RESULTS:: Of 60 total patients, 46 underwent the complete treatment plan (median age: 60.1 years; adenocarcinoma: 25 patients; squamous cell cancer: 21 patients). A major pathological response occurred in 45.7% of patients and was associated with a favorable outcome (P = 0.057). Neoadjuvant CRT led to a significant reduction in intratumoral FDG-uptake (P < 0.001). No significant association was seen between a pathological response (either complete or major) and the FDG-PET results (P > 0.280). The SUV2 value was correlated with a morphological response and the possibility to perform an R0 resection (P < 0.018; receiver operating characteristic curve analysis: SUV2 threshold = 5.5). No significant association was found between metabolic imaging and recurrence or survival. CONCLUSIONS:: FDG-PET does not effectively correlate with pathological response and long-term survival in patients with locally advanced esophageal cancer undergoing neoadjuvant CRT followed by surgery.

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