FDG PET/CT patterns of treatment failure of malignant pleural mesothelioma: relationship to histologic type, treatment algorithm, and survival
FDG PET/CT patterns of treatment failure of malignant pleural mesothelioma: relationship to histologic type, treatment algorithm, and survival
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DOI：
10.1007/s00259-010-1704-x
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发表时间：
2011-05-01
影响因子：
9.1
通讯作者：
Sugarbaker, David J.
中科院分区：
文献类型：
--
作者：
Gerbaudo, Victor H.;Mamede, Marcelo;Sugarbaker, David J.
本研究探讨了氟脱氧葡萄糖（FDG）正电子发射断层扫描(PET)/CT在疑似恶性胸膜间皮瘤（MPM）复发中的诊断性能和预后价值，包括FDG摄取的模式和强度、组织学类型和治疗方法。50例MPM患者在治疗后11 +/- 6个月接受FDG PET/CT检查。肿瘤复发经组织病理学、临床进展及后续影像学证实。无进展生存期定义为从治疗到最早出现复发的临床证据之间的时间。FDG PET/CT后的生存时间定义为扫描到死亡或最后一次随访之间的时间。总生存期定义为首次治疗到死亡或最后一次随访日期之间的时间。42例患者（30例上皮性MPM和12例非上皮性MPM）证实治疗失败。FDG PET/CT的敏感性、特异性、准确性、阴性预测值和阳性预测值分别为97.6、75、94、86和95.3%。FDG PET/CT显示同侧半胸18例（44%），对侧2例（5%），腹部1例（2%）。3例（7%）患者双侧胸部复发。10例（24%）患者在同侧半胸和腹部同时复发，7例（17%）患者在所有三个腔中同时复发。11例（26%）患者未发现远处转移。在复发性疾病中观察到四种摄取模式：局灶性、线状、混合性（局灶/线状）和包膜性，与治疗后良性病变相比，恶性病变的摄取强度有显著差异。病变摄取在先前接受更积极治疗的患者中较低，而在远处转移患者的胸内病变中较高。FDG PET/CT帮助选择了12名患者（29%），这些患者在失败时受益于额外的先前计划外治疗。多变量分析显示，组织学类型仍然是无进展生存期的唯一独立预测因子。复发后的生存可通过FDG摄取模式和PET节点状态独立预测，总生存可通过最大标准摄取值独立预测。FDG PET/CT是一种准确诊断和估计局部及远处MPM复发程度的方法，具有独立的预后价值。一旦疾病复发，生存结果似乎与组织学类型无关，高度依赖于病变摄取的强度和FDG PET/CT上代谢活跃的疾病模式。我们的观察应被认为仅限于手术治疗或不围手术期治疗的患者，而不应推断到那些仅用化疗治疗的不可切除病例。
This study investigated the diagnostic performance and prognostic value of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in suspected malignant pleural mesothelioma (MPM) recurrence, in the context of patterns and intensity of FDG uptake, histologic type, and treatment algorithm.Fifty patients with MPM underwent FDG PET/CT for restaging 11 +/- 6 months after therapy. Tumor relapse was confirmed by histopathology, and by clinical evolution and subsequent imaging. Progression-free survival was defined as the time between treatment and the earliest clinical evidence of recurrence. Survival after FDG PET/CT was defined as the time between the scan and death or last follow-up. Overall survival was defined as the time between initial treatment and death or last follow-up date.Treatment failure was confirmed in 42 patients (30 epithelial and 12 non-epithelial MPM). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for FDG PET/CT were 97.6, 75, 94, 86, and 95.3%, respectively. FDG PET/CT evidence of single site of recurrence was observed in the ipsilateral hemithorax in 18 patients (44%), contralaterally in 2 (5%), and in the abdomen in 1 patient (2%). Bilateral thoracic relapse was detected in three patients (7%). Simultaneous recurrence in the ipsilateral hemithorax and abdomen was observed in ten (24%) patients and in seven (17%) in all three cavities. Unsuspected distant metastases were detected in 11 patients (26%). Four patterns of uptake were observed in recurrent disease: focal, linear, mixed (focal/linear), and encasing, with a significant difference between the intensity of uptake in malignant lesions compared to benign post-therapeutic changes. Lesion uptake was lower in patients previously treated with more aggressive therapy and higher in intrathoracic lesions of patients with distant metastases. FDG PET/CT helped in the selection of 12 patients (29%) who benefited from additional previously unplanned treatment at the time of failure. Multivariate analysis showed that histologic type remained the only independent predictor of progression-free survival. Survival after relapse was independently predicted by the pattern of FDG uptake and PET nodal status, and overall survival by the maximum standard uptake value.FDG PET/CT is an accurate modality to diagnose and to estimate the extent of locoregional and distant MPM recurrence, and it carries independent prognostic value. Once the disease recurs, survival outcomes seem to be independent of histologic type and highly dependent on the intensity of lesion uptake and on the pattern of metabolically active disease in FDG PET/CT. Our observations should be considered limited to patients treated surgically with or without perioperative therapies and should not be extrapolated to those unresectable cases treated with chemotherapy alone.