Prognostic significance of metabolic response by positron emission tomography after neoadjuvant chemotherapy for resectable malignant pleural mesothelioma
Prognostic significance of metabolic response by positron emission tomography after neoadjuvant chemotherapy for resectable malignant pleural mesothelioma
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DOI：
10.1093/annonc/mds537
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发表时间：
2013-04-01
影响因子：
50.5
通讯作者：
Okada, M.
中科院分区：
文献类型：
--
作者：
Tsutani, Y.;Takuwa, T.;Okada, M.
为了选择胸膜外肺切除术（EPP）的最佳候选人，我们在一项多中心研究中回顾性评估了氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在新辅助化疗后代谢反应的有效性，以预测可切除的恶性胸膜间皮瘤（MPM）患者接受EPP的预后。我们对50例临床T1-3 N0-2 M0 MPM患者行EPP +/-术后半胸放疗，在新辅助铂基化疗前后分别行高分辨率CT （HRCT）和FDG-PET/CT。肿瘤最大标准化摄取值（SUVmax）降低bb0 = 30%被定义为代谢应答者。使用改良的RECIST或代谢反应的放射学反应和手术结果进行分析。诊断后的中位总生存期（OS）为20.5个月。代谢应答者与OS显著相关，未达到代谢应答者的中位OS为18.7个月，无应答者为18.7个月。放射应答者和无应答者的中位OS与OS之间没有相关性。基于多变量Cox分析，SUVmax降低和上皮样亚型是OS的显著独立因素。新辅助化疗后的代谢反应是可切除MPM患者的独立预后因素。代谢应答或上皮样亚型的患者可能是EPP的良好候选人。
To select optimal candidates for extrapleural pneumonectomy (EPP), we retrospectively evaluated the usefulness of metabolic response by fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) after neoadjuvant chemotherapy to predict prognosis for patients with resectable malignant pleural mesothelioma (MPM) who underwent EPP in a multicenter study.We carried out high-resolution CT (HRCT) and FDG-PET/CT before and after neoadjuvant platinum-based chemotherapy on 50 patients with clinical T1-3 N0-2 M0 MPM who underwent EPP +/- postoperative hemithoracic radiotherapy. A decrease of >= 30% in the tumor maximum standardized uptake value (SUVmax) was defined as a metabolic responder. The radiologic response using the modified RECIST or metabolic response and surgical results were analyzed.The median overall survival (OS) from diagnosis was 20.5 months. Metabolic responders significantly correlated to OS with median OS for metabolic responders not reached versus 18.7 months for non-responders. No correlation was observed between OS and radiologic response with median OS for radiologic responders and non-responders. Based on the multivariate Cox analyses, decreased SUVmax and epithelioid subtype were significantly independent factors for OS.The metabolic response after neoadjuvant chemotherapy is an independent prognostic factor for patients with resectable MPM. Patients with metabolic responder or epithelioid subtype may be good candidates for EPP.