The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: Results of the American College of Surgeons Oncology Group Z0060 trial
The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: Results of the American College of Surgeons Oncology Group Z0060 trial
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DOI：
10.1016/j.jtcvs.2006.09.079
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发表时间：
2007-03-01
影响因子：
6
通讯作者：
Putnam, Joe B., Jr.
中科院分区：
文献类型：
--
作者：
Meyers, Bryan F.;Downey, Robert J.;Putnam, Joe B., Jr.
目的：美国外科医师学会肿瘤组试验Z 0060是一项前瞻性多机构试验，主要目的是评估F-18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）是否能检测到常规分期后的食管癌手术候选人中排除食管切除术的炎症性疾病证据。方法：在胸部和腹部计算机断层扫描显示无转移证据后，入选了可切除的活检证实的癌症患者。FDG-PET根据规定的标准进行。FDG-PET结果表明转移需要确认，PET上没有转移的患者预计将进行手术。结果：共登记了262例患者。其中，199例被认为合格，其中189例患者可评价。73例患者不合格或无法评价。不合格的原因包括常规分期的不可切除疾病（39）、缺失或过时的分期程序（12）、PET技术方案违反（10）、无癌症（4）、PET前诱导治疗（3）、幽闭恐怖症（1）和其他原因（4）。有145例（78%）患者继续接受手术，42例（22%）未接受手术，2例患者的手术状态未确定。未切除的原因包括：PET发现并确认的M1疾病（9），PET发现但未确认的M1疾病（2），PET未发现探查时的M1疾病（7），术前下降或死亡（10），患者拒绝手术（7），探查时不可切除的局部肿瘤（5），以及排除手术的广泛N1疾病（2）。8例（4.2%）患者接受切除术复发，在第一个6 months.Conclusions：虽然22%的合格患者没有接受食管切除术，FDG-PET后，食管癌的标准临床分期确定确认M1 b疾病在至少4.8%（95%置信区间：2.2%-8.9%）的患者切除术前。未经证实的PET证据M1疾病和区域性淋巴结病（N1疾病）导致其他患者接受明确的非手术或诱导治疗。
Objectives: The American College of Surgeons Oncology Group trial Z0060 is a prospective multi-institutional trial with a primary objective to evaluate whether positron emission tomography ( PET) with F-18 fluorodeoxyglucose (FDG) detects evidence of metastastic disease that precludes esophagectomy in patients with esophageal cancer who are surgical candidates after routine staging.Methods: Patients with resectable, biopsy-proven carcinoma were enrolled after computed tomography of chest and abdomen demonstrated no evidence of metastasis. FDG-PET was performed according to specified standards. FDG-PET findings suggesting metastases required confirmation and patients without metastases on PET were expected to proceed to surgery.Results: A total of 262 patients were registered. Of these, 199 were deemed eligible and of these, 189 patients were evaluable. Seventy-three patients were ineligible or unevaluable. Reasons for ineligibility included nonresectable disease by routine staging (39), missing or outdated staging procedures (12), PET technical protocol violations (10), no cancer (4), pre-PET induction therapy (3), claustrophobia (1), and other causes (4). There were 145 (78%) patients who went on to have surgery, 42 (22%) who did not, and 2 patients for whom the surgical status was not determined. The reasons for no resection included the following: M1 disease found by PET and confirmed (9), M1 disease found by PET and not confirmed (2), M1 disease at exploration not found by PET (7), decline or death before surgery (10), patient refusal of surgery (7), unresectable local tumor at exploration (5), and extensive N1 disease precluding operation (2). Eight (4.2%) patients undergoing resection had a recurrence in the first 6 months.Conclusions: Although 22% of eligible patients did not undergo esophagectomy, FDG-PET after standard clinical staging for esophageal carcinoma identified confirmed M1b disease in at least 4.8% (95% confidence interval: 2.2%-8.9%) of patients before resection. Unconfirmed PET evidence of M1 disease and regional adenopathy (N1 disease) led to definitive nonsurgical or induction therapy in additional patients.