3′-Deoxy-3′-18F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer
3′-Deoxy-3′-18F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer
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DOI：
10.1007/s00259-015-3000-2
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发表时间：
2015-05-01
影响因子：
9.1
通讯作者：
Sharma, Rohini
中科院分区：
文献类型：
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作者：
Challapalli, Amarnath;Barwick, Tara;Sharma, Rohini
目的 由于示踪剂的生理性肝脏摄取较高，3'-脱氧-3'-F-18-氟胸苷 (FLT) 正电子发射断层扫描 (PET) 在腹部成像中的实用性有限。我们评估了 FLT PET/CT 与基于时间强度信息的体素聚类方法（称为动态空间过滤 (FLT PET/CTKSF)）相结合，对接受吉西他滨化疗的局部晚期和转移性胰腺癌患者的反应和生存结果进行早期预测。方法在第一个化疗周期之前和之后 3 周收集动态 FLT PET/CT 数据。确定了肿瘤 FLT PET/CT 变量的变化。主要终点是治疗 3 个月后对比增强 CT 的 RECIST 1.1 反应。结果 纳入 20 名患者。在 FLT PETKSF 图像中可以看到肿瘤和正常胰腺之间的视觉区别。所有目标病灶（> 2 cm），包括所有原发性胰腺肿瘤，均被可视化。在 11 个肝转移中，有 3 个（< 2 cm）在动态过滤后不可见。 20 名患者中，7 名病情进展（35%）。疾病进展患者中注射后 60 分钟的最大标准化摄取值 (SUV60,max) 显着增加 (p = 0.04)。受试者工作特征曲线分析表明，阈值 SUV60、最大千分之一日元和千分之一欧元增加 12% 导致预测患者疾病进展的敏感性、特异性和阳性预测值 (PPV) 分别为 71%、100% 和 100% [曲线下面积 (AUC) 0.90，p = 0.0001]。 SUV60,max 的变化不能预测生存。结论 FLT PET/CT 检测到增殖的变化，SUV60,max 的早期增加以高特异性和 PPV 预测进展性疾病。因此，FLT PET/CT 可用作基于吉西他滨的化疗的早期反应生物标志物，以选择可能受益于晚期和转移性胰腺癌新治疗药物的预后不良群体。
Purpose 3'-Deoxy-3'-F-18-fluorothymidine (FLT) positron emission tomography (PET) has limited utility in abdominal imaging due to high physiological hepatic uptake of tracer. We evaluated FLT PET/CT combined with a temporal-intensity information-based voxel-clustering approach termed kinetic spatial filtering (FLT PET/CTKSF) for early prediction of response and survival outcomes in locally advanced and metastatic pancreatic cancer patients receiving gemcitabine-based chemotherapy.Methods Dynamic FLT PET/CT data were collected before and 3 weeks after the first cycle of chemotherapy. Changes in tumour FLT PET/CT variables were determined. The primary end point was RECIST 1.1 response on contrast-enhanced CT after 3 months of therapy.Results Twenty patients were included. Visual distinction between tumours and normal pancreas was seen in FLT PETKSF images. All target lesions (> 2 cm), including all primary pancreatic tumours, were visualised. Of the 11 liver metastases, 3 (< 2 cm) were not visible after kinetic filtering. Of the 20 patients, 7 progressed (35 %). Maximum standardised uptake value at 60 min post-injection (SUV60,max) significantly increased in patients with disease progression (p = 0.04). Receiver-operating characteristic curve analysis indicated that a threshold of SUV60,max increase of a parts per thousand yenaEuro parts per thousand 12 % resulted in sensitivity, specificity and positive predictive value (PPV) of 71, 100 and 100 %, respectively [area under the curve (AUC) 0.90, p = 0.0001], to predict patients with disease progression. Changes in SUV60,max were not predictive of survival.Conclusion FLT PET/CT detected changes in proliferation, with early increase in SUV60,max predicting progressive disease with a high specificity and PPV. Therefore, FLT PET/CT could be used as an early response biomarker for gemcitabine-based chemotherapy, to select a poor prognostic group who may benefit from novel therapeutic agents in advanced and metastatic pancreatic cancer.