Dual-phase 18F-fluoro-2-deoxy-d-glucose positron emission tomography as a prognostic parameter in patients with pancreatic cancer
Tóm tắt
Recently, dual-phase 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) was shown to be useful in the differentiation between malignant and benign pancreatic lesions. The aim of this prospective study was to evaluate the value of dual-phase FDG-PET as a prognostic parameter in patients with pancreatic cancer. Sixty-five consecutive patients with pancreatic cancer underwent dual-phase FDG-PET. Standardised uptake values at 1 h (SUV1) and 2 h (SUV2) following the injection of FDG were determined, and the retention index (RI) was calculated by dividing the difference between SUV2 and SUV1 by SUV1. The prognostic value of SUV1, SUV2 and RI was analysed, along with the various clinical and biochemical parameters. Multivariate analysis showed that only three factors had an independent association with longer patient survival: female gender (p<0.01), TNM stage I–III (p<0.05) and RI>10% (p<0.01). Neither SUV1 nor SUV2 showed any prognostic significance. Combination of tumour stage and RI allowed more accurate prognostic evaluation. Patients at stage I–III with RI>10% survived longer than did patients at the same stage with RI<10% (15.3 vs 11.5 months, p<0.01). Patients at stage IV with RI>10% had an intermediate prognosis, with a median survival of 9.5 months; patients at stage IV with RI<10% showed the worst prognosis, with a median survival of 4.9 months (p<0.05). RI calculated with dual-phase FDG-PET can be used not only as a tool for initial diagnosis and staging of pancreatic cancer but also as a strong independent prognostic parameter that can allow accurate identification of those patients who will benefit from intensive anticancer treatment at different stages of the disease.
Tài liệu tham khảo
Sarmiento JM, Sarr MG. Staging strategies for pancreatic adenocarcinoma: what the surgeon really wants to know. Curr Gastroenterol Rep 2003;5:117–24.
Kitagawa T, Tsukuma H. Prediction of cancer incidence in Japan. In: Tominaga S, editor. Cancer statistics—1999. Tokyo: Shinohara Shuppan; 1999.
Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J Clin 2003;53:5–26.
Yeo CJ, Cameron JL. Prognostic factors in ductal pancreatic cancer. Langenbecks Arch Surg 1998;383:129–33.
Lillemoe KD, Pitt HA. Palliation. Surgical and otherwise. Cancer 1996;78:605–14.
Engelken FJF, Bettschart V, Rahman MQ, Parks RW, Garden OJ. Prognostic factors in the palliation of pancreatic cancer. Eur J Surg Oncol 2003;29:368–73.
Higashi T, Saga T, Nakamoto Y, Ishimori T, Fujimoto K, Doi R, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET)—usefulness and limitations in “clinical reality”. Ann Nucl Med 2003;17:261–79.
Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Doi R, et al. Delayed 18F-fluoro-2-deoxy-d-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer 2000;89:2547–54.
UICC TNM. Classification of malignant tumors. 6th edn. New York: Wiley-Liss; 2002.
Kitano H, Magata Y, Tanaka A, Mukai T, Kuge Y, Nagatsu K, et al. Performance assessment of O-18 water purifier. Ann Nucl Med 2001;15:75–8.
Bramhall SR, Allum WH, Jones AG, Allwood A, Cummins C, Neoptolemos JP. Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg 1995;82:111–5.
Ghaneh P, Kawesha A, Evans JD, Neoptolemos JP. Molecular prognostic markers in pancreatic cancer. J Hepatobiliary Pancreat Surg 2002;9:1–11.
Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma. A population-based, linked database analysis of 396 patients. Ann Surg 2003;237:74–85.
Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993;165:68–72.
Maclean GD, Reddish MA, Longnecker BM. Prognostic significance of preimmunotherapy serum CA27.29 (MUC 1) mucin level after specific immunotherapy of metastatic adenocarcinoma patients. J Immunother 1997;20:70–8.
Griffin JF, Smalley SR, Jewell W, Paradelo JC, Reymond RD, Hassanein RE, Evans RG. Patterns of failure after curative resection of pancreatic carcinoma. Cancer 1990;66:56–61.
Morganti AG, Valentini V, Macchia G, Alfieri S, Trodella L, Brizi MG, et al. Adjuvant radiotherapy in resectable pancreatic carcinoma. Eur J Surg Oncol 2002;28:523–30.
Kanemitsu K, Hiraoka T, Tsuji T, Inoue K, Takamori H. Implication of micrometastases of lymph nodes in patients with extended operation for pancreatic cancer. Pancreas 2003;26:315–21.
Phelps ME, Huang SC, Hoffman EJ, Selin C, Sokoloff L, Kuhl DE. Tomographic measurement of local cerebral glucose metabolic rate in humans with (F-18)2-fluoro-2-deoxy-d-glucose: validation of method. Ann Neurol 1979;6:371–88.
Higashi T, Tamaki N, Honda T, Torizuka T, Kimura T, Inokuma T, et al. Expression of glucose transporters in human pancreatic tumors compared with increased FDG accumulation in PET study. J Nucl Med 1997;38:1337–44.
Reske SN, Grillenberger KG, Glatting G, Port M, Hildebrandt M, Gansauge F, Beger HG. Overexpression of glucose transporter 1 and increased FDG uptake in pancreatic carcinoma. J Nucl Med 1997;38:1344–8.
Bares R, Klever P, Hauptmann S, Hellwig D, Fass J, Cremerius U, et al. F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology 1994;192:79–86.
Diederichs CG, Staib L, Vogel J, Glasbrenner B, Glatting G, Brambs HJ, et al. Values and limitations of 18F-fluorodeoxyglucose-positron-emission tomography with preoperative evaluation of patients with pancreatic masses. Pancreas 2000;20:109–16.
Delbeke D, Rose DM, Chapman WC, Pinson CW, Wright JK, Beauchamp RD, et al. Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med 1999;40:1784–91.
Buck A, Schirrmeister H, Kuhn T, Shen C, Kalker T, Kotzerke J, et al. FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters. Eur J Nucl Med Mol Imaging 2002;29:1317–23.
Halfpenny W, Hain SF, Biassoni L, Maisey MN, Sherman JA, McGurk M. FDG-PET. A possible prognostic factor in head and neck cancer. Br J Cancer 2002;86:512–6.
Dhital K, Saunders CA, Seed PT, O’Doherty MJ, Dussek J. [18F]Fluorodeoxyglucose positron emission tomography and its prognostic value in lung cancer. Eur J Cardiothorac Surg 2000;18:425–8.
Nakata B, Chung YS, Nishimura S, Nishihara T, Sakurai Y, Sawada T, et al. 18F-fluorodeoxyglucose positron emission tomography and the prognosis of patients with pancreatic adenocarcinoma. Cancer 1997;79:695–9.
Nakata B, Nishimura S, Ishikawa T, Ohira M, Nishino H, Kawabe J, et al. Prognostic predictive value of 18F-fluorodeoxyglucose positron emission tomography for patients with pancreatic cancer. Int J Oncol 2001;19:53–8.
Zimny M, Fass J, Bares R, Cremerius U, Sabri O, Buechin P, et al. Fluorodeoxyglucose positron emission tomography and the prognosis of pancreatic carcinoma. Scand J Gastroenterol 2000;35:883–8.
Sperti C, Pasquali C, Chierichetti F, Ferronato A, Decet G, Pedrazzoli S. 18-Fluorodeoxyglucose positron emission tomography in predicting survival of patients with pancreatic carcinoma. J Gastrointest Surg 2003;7:953–60.
Keyes JW. SUV: standard uptake or silly useless value? J Nucl Med 1995;36:1836–9.
Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992;33:1972–80.
Nakamoto Y, Saga T, Ishimori T, Higashi T, Mamede M, Okazaki K, et al. FDG-PET of autoimmune-related pancreatitis: preliminary results. Eur J Nucl Med 2000;27:1835–8.