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目的据报道,在新辅助化疗过程中或之后行正电子发射体层摄影(PET)示肿瘤18F-脱氧葡萄糖(FDG)摄取减低,可预测食管癌的病理学缓解。我们的目的是在前瞻性临床实验中应用标准化新辅助化疗方案来确定代谢反应是否可预测病理学缓解。方法一项非随机临床试验,包括接受治疗的潜在可治愈的食管癌病人。使用标准化化疗方案(奥沙利铂和5-氟尿嘧啶两个疗程)。化疗前行PET/CT,且在第2疗程开始后24～28d复查PET/CT。结果入选48例,平均年龄65岁,男性37例。应用最大标准摄取值(SUVmax)(42%)中位百分比降低来定义代谢反应,病理学缓解可见于71%(17/24)的代谢反应,无反应者为33%(8/24;P=0.009,敏感度68%,特异度70%)。病理学缓解可见于81%(13/16)具有完全代谢反应的病例和38%不完全代谢反应的病例(12/32;P=0.0042,敏感度52%,特异度87%),但无基于组织学的显著效应。结论代谢反应与病理学缓解之间具有显著相关性,但预测病理学缓解的准确性仍相对较低。要点①PET/CT可预测食管癌病人其肿瘤对化疗的反应。②采用标准化化疗的前瞻性研究。③PET/CT表现和疾病反应之间具有显著相关性。④然而预测病理学缓解的准确性仍相对较低。
PURPOSE It was reported that positron emission tomography (PET) imaging of neoplastic 18F-FDG uptake during or after neoadjuvant chemotherapy is predictive of pathological response to esophageal cancer. Our goal is to use standardized neoadjuvant chemotherapy regimens in prospective clinical trials to determine if metabolic responses predict pathologic remission. Methods A non-randomized clinical trial included potentially curable esophageal cancer patients undergoing treatment. Standard chemotherapy (oxaliplatin and 5-fluorouracil in two courses) was used. PET / CT was performed before chemotherapy, and PET / CT was reviewed 24 to 28 days after the start of the second course of treatment. Results of the selected 48 cases, the average age of 65 years old, 37 males. Metabolic responses were defined as a reduction in the median percentage of maximal normalized uptake (SUVmax) (42%) and pathologic responses were found in 71% (17/24) of the metabolic reactions with 33% (8/24; P = 0.009, sensitivity 68%, specificity 70%). Pathologic remission can be seen in 81% (13/16) cases with complete metabolic response and 38% incomplete metabolic reactions (12/32; P = 0.0042, 52% sensitivity, 87% specificity) Histological significant effect. Conclusion There is a significant correlation between metabolic reaction and pathological remission, but the accuracy of predicting pathological remission is still relatively low. Point ① PET / CT can predict the response of esophageal cancer patients to chemotherapy. ② using standardized chemotherapy prospective study. ③ PET / CT performance and disease response was significantly correlated. However, the accuracy of predictive pathology remission is still relatively low.