Preoperative FDG-Positive Lymph Nodes Predict the Postoperative Prognosis in Resectable Biliary Tract Cancers
Preoperative FDG-Positive Lymph Nodes Predict the Postoperative Prognosis in Resectable Biliary Tract Cancers
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DOI：
10.1245/s10434-021-10820-6
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发表时间：
2021-09-29
影响因子：
3.7
通讯作者：
Eguchi, Hidetoshi
中科院分区：
文献类型：
--
作者：
Kubo, Masahiko;Kobayashi, Shogo;Eguchi, Hidetoshi
背景 F-18 氟脱氧葡萄糖正电子发射断层扫描 (FDG-PET) 已用于诊断各种癌症并对其进行分期。对于胆道癌（BTC），由于胆管炎，很难评估癌症引起的 FDG 摄取。我们之前表明，可切除 BTC 的 FDG 阳性淋巴结 (LN) 有可能预测术后预后。目的 本研究旨在使用另一个队列验证 FDG-PET 对 LN 的可用性，并详细研究 FDG 阳性 LN 与 BTC 预后之间的关系。方法 我们测量了 67 名患者 190 个手术解剖的 LN 区域的术前最大标准化摄取值 (SUVmax)，并使用我们之前确定的 SUVmax 截止值 (>= 2.8) 研究预后。结果 关于可切除 BTC 患者的预后，与 LN SUVmax < 2.8 [PET N (-)] 相比，LN SUVmax >= 2.8 [PET N (+)] 是无复发生存 (RFS) 的不良预后因素。经证实，RFS 的风险比森林图 [PET N (+)/PET N (-)] 表明子类别之间存在类似趋势。此外，我们调查了 pN0 疾病患者，结果表明，与 PET N (-) 组相比，PET N (+) 组的 RFS 结果也明显较差。 PET N (+) 组的淋巴结复发率明显高于 PET N (-) 组。结论 高 LN SUVmax 被证实是术前诊断的可切除 BTC 中 RFS 的预后危险因素，有助于临床决策围手术期治疗策略。
Background F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) has been used to diagnose and stage various cancers. In regard to biliary tract cancer (BTC), due to cholangitis it is difficult to evaluate FDG uptake caused by cancer. We previously showed that FDG-positive lymph nodes (LNs) of resectable BTC had a possibility of predicting postoperative prognosis. Objective This study aimed to validate the usability of FDG-PET for LNs using another cohort and to investigate in detail the relationship between FDG-positive LNs and the prognosis of BTC. Methods We measured the preoperative maximum standardized uptake value (SUVmax) at each of the 190 surgically dissected LN areas in 67 patients and investigated the prognosis using our previously determined SUVmax cut-off values of >= 2.8. Results Regarding the prognosis of patients with resectable BTC, a LN SUVmax >= 2.8 [PET N (+)] was a poor prognostic factor for recurrence-free survival (RFS) compared with a LN SUVmax < 2.8 [PET N (-)]. It was confirmed that the hazard ratio forest plot [PET N (+)/PET N (-)] for RFS indicated a similar tendency among subcategories. Moreover, we investigated patients with pN0 disease and demonstrated that the PET N (+) group also had a significantly worse RFS outcome compared with the PET N (-) group. Recurrence of the PET N (+) group has significantly occurred more often in LNs than that of the PET N (-) group. Conclusion High LN SUVmax was confirmed to be the preoperatively diagnosed prognostic risk factor for RFS in resectable BTC and could be helpful for clinical decision making regarding the perioperative treatment strategy.