Use of carcinoembryonic antigen radioimmunodetection and computed tomography for predicting the resectability of recurrent colorectal cancer.
Use of carcinoembryonic antigen radioimmunodetection and computed tomography for predicting the resectability of recurrent colorectal cancer.
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DOI：
10.1097/00000658-199711000-00007
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发表时间：
1997-11
影响因子：
9
通讯作者：
K. Hughes;C. Pinsky;N. Petrelli;F. Moffat;Y. Patt;L. Hammershaimb;D. Goldenberg
中科院分区：
文献类型：
--
作者：
K. Hughes;C. Pinsky;N. Petrelli;F. Moffat;Y. Patt;L. Hammershaimb;D. Goldenberg
目的 目的是确定 arcitumomab（CEA-Scan；Immunomedics，Morris Plains，NJ）（一种锝-99m 标记的抗癌胚抗原 (CEA) Fab'）在复发性或转移性结直肠癌患者的术前评估中的作用。摘要背景数据手术切除是已知治愈复发性或转移性结直肠癌的唯一方法。手术前必须确定疾病的位置和范围。抗体成像（一种新的癌症检测方式）在局部复发或转移性结直肠癌切除术前评估中的作用尚未确定，无论是单独使用还是与标准诊断方式结合使用。方法 在对 209 名已知或疑似结直肠癌患者进行的盲法分析中，通过将结果与手术和组织病理学结果相关联，将 arcitumomab 单独使用以及与计算机断层扫描 (CT) 联合使用的准确性与 CT 预测腹盆腔肿瘤可切除性的准确性进行比较。结果发现，单独使用 Arcitumomab 或与 CT 联合使用在预测手术结果方面比单独使用 CT 更准确。当 CT 和 arcitumomab 的结果在腹盆腔可切除性、不可切除性或无疾病方面一致时，预测准确度分别为 67%、100% 和 64%。因此，不可切除性的一致性（100%正确）可能会消除对其他诊断方式或探查手术的需要。当两项测试不一致时，arcitumomab 的正确率明显高于 CT。由于肝脏是结直肠癌远处转移最常见的部位，因此还对一部分患有肝病的患者进行了分析；研究结果与总体可切除性结果相似。该产品的安全性非常出色：针对arcitumomab 的免疫反应诱导发生率<1%，潜在不良事件发生率为1.2%。结论：arcitumomab 评估可切除性状态的准确性高于 CT，无论是在所有接受结直肠癌根治性腹盆腔切除术评估的患者中，还是在疑似或确诊肝转移的患者亚组中。在 CT 中额外使用 arcitumomab 可能会使可以节省不必要的腹盆腔手术的费用、发病率和死亡率的患者数量增加一倍，并使可能可切除治愈的患者数量增加 40%。
OBJECTIVE The objective was to determine the role of arcitumomab (CEA-Scan; Immunomedics, Morris Plains, NJ), an anticarcinoembryonic antigen (CEA) Fab' labeled with technetium-99m, in the presurgical evaluation of patients with recurrent or metastatic colorectal carcinoma. SUMMARY BACKGROUND DATA Surgical resection is the only method known to cure recurrent or metastatic colorectal carcinoma. The location and extent of disease must be determined before surgery. The role of antibody imaging, a new cancer detection modality, in preoperative evaluation for resection of locally recurrent or metastatic colorectal cancer has not been established, either alone or in combination with standard diagnostic modalities. METHODS In a blinded analysis of 209 patients with known or suspected colorectal cancer, the accuracy of arcitumomab, alone and combined with computed tomography (CT), was compared to that of CT for predicting abdominopelvic tumor resectability by correlating the results with surgical and histopathologic findings. RESULTS Arcitumomab alone or combined with CT was found to be significantly more accurate for predicting surgical outcome than CT alone. When the results of CT and arcitumomab were concordant for abdominopelvic resectability, nonresectability, or absence of disease, the prediction was accurate in 67%, 100%, and 64%, respectively. Thus, the concordance for nonresectability (100% correct) may obviate the need for other diagnostic modalities or exploratory surgery. When the two tests were discordant, arcitumomab was correct substantially more often than CT. Because the liver is the most common site of distant metastasis in colorectal cancer, a subset of patients with hepatic disease was also analyzed; findings were similar to the overall resectability results. The product's safety profile was excellent: the incidence of induction of an immune response against arcitumomab was <1% and that of potentially adverse events was 1.2%. CONCLUSIONS The accuracy of arcitumomab for assessing resectability status is greater than that of CT, both in all patients undergoing evaluation for curative abdominopelvic resection of colorectal cancer and in the subset of patients with suspected or proven liver metastases. The additional use of arcitumomab with CT potentially doubles the number of patients who could be saved the cost, morbidity, and mortality of unnecessary abdominopelvic surgery and increases those who are potentially resectable for cure by 40%.