Prognostic value of 18F‐fluoroazomycin arabinoside PET/CT in patients with advanced non‐small‐cell lung cancer

This study evaluated the prognostic value of positron emission tomography/computed tomography (PET/CT) using ¹⁸F‐fluoroazomycin arabinoside (FAZA) in patients with advanced non‐small‐cell lung cancer (NSCLC) compared with ¹⁸F‐fluorodeoxyglucose (FDG). Thirty‐eight patients with advanced NSCLC (stage III, 23 patients; stage IV, 15 patients) underwent FAZA and FDG PET/CT before treatment. The PET parameters (tumor‐to‐muscle ratio [T/M] at 1 and 2 h for FAZA, maximum standardized uptake value for FDG) in the primary lesion and lymph node (LN) metastasis and clinical parameters were compared concerning their effects on progression‐free survival (PFS) and overall survival (OS). In our univariate analysis of all patients, clinical stage and FAZA T/M in LNs at 1 and 2 h were predictive of PFS (P = 0.021, 0.028, and 0.002, respectively). Multivariate analysis also indicated that clinical stage and FAZA T/M in LNs at 1 and 2 h were independent predictors of PFS. Subgroup analysis of chemoradiotherapy‐treated stage III patients revealed that only FAZA T/M in LNs at 2 h was predictive of PFS (P = 0.025). The FDG PET/CT parameters were not predictive of PFS. No parameter was a significant predictor of OS. In patients with advanced NSCLC, FAZA uptake in LNs, but not in primary lesions, was predictive of treatment outcome. These results suggest the importance of characterization of LN metastases in advanced NSCLC patients.     

Prognostic models integrating quantitative parameters from baseline and interim positron emission computed tomography in patients with diffuse large B-cell lymphoma: post-hoc analysis from the SAKK38/07 clinical trial

Positron emission computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) enrolled in a prospective clinical trial were reviewed to test the impact of quantitative parameters from interim PET/CT scans on overall (OS) and progression-free (PFS) survival. We centrally reviewed baseline and interim PET/CT scans of 138 patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone given every 14 days (R-CHOP14) in the SAKK38/07 trial ( ClinicalTrial.gov identifier: NCT00544219). Cutoff values for maximum standardized uptake value (SUV_max), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and metabolic heterogeneity (MH) were defined by receiver operating characteristic analysis. Responses were scored using the Deauville scale (DS). Patients with DS 5 at interim PET/CT (defined by uptake >2 times higher than in normal liver) had worse PFS (P = 0.014) and OS (P < 0.0001). A SUV_max reduction (Δ) greater than 66% was associated with longer PFS (P = 0.0027) and OS (P < 0.0001). Elevated SUV_max, MTV, TLG, and MH at interim PET/CT also identified patients with poorer outcome. At multivariable analysis, ΔSUV_max and baseline MTV appeared independent outcome predictors. A prognostic model integrating ΔSUV_max and baseline MTV discriminated three risk groups with significantly (log-rank test for trend, P < 0.0001) different PFS and OS. Moreover, the integration of MH and clinical prognostic indices could further refine the prediction of OS. PET metrics-derived prognostic models perform better than the international indices alone. Integration of baseline and interim PET metrics identified poor-risk DLBCL patients who might benefit from alternative treatments.     

A study on the clinical value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography combined with serum squamous cell carcinoma antigen in diagnosing recurrence/metastases in patients with early metaphase cervical cancer

Cervical cancer (CC) is the most common female genital tract malignancy, with repercussions on the psychophysiological health of female patients. Patients with CC are faced with a high risk of postoperative recurrence and metastases. The present study aimed to evaluate the clinical value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) combined with serum squamous cell carcinoma antigen (SCC-Ag) in the diagnosis of postoperative recurrence/metastases in patients with early stage CC. This was a prospective follow-up study on 246 patients who received surgery for early stage CC. The results of clinical follow-up and pathological examination were taken as the gold standard. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic (ROC) curve were calculated for PET/CT, serum SCC-Ag determination and the combined PET/CT and serum SCC-Ag method. Results demonstrated that 90.11% patients completed the follow-up, and the median follow-up time was 22 months (range, 7–42 months). Tumor recurrence or metastasis was confirmed in a total of 137 patients (55.7%), including 18 deaths. The diagnostic sensitivity of PET/CT scan combined with serum SCC-Ag determination for postoperative metastases/recurrence in patients with early stage CC was 93.43% (95% CI, 0.875–0.967). The specificity was 92.67% (95% CI, 0.856–0.965), the positive predictive value was 94.12% (95% CI, 0.884–0.972), the negative predictive value was 91.81% (95% CI, 0.846–0.959) and the area under the ROC curve was 0.930±0.019 (95% CI, 0.893–0.968; P<0.001). The results also revealed that the serum SCC-Ag level was positively correlated with SUVmax (r=0.458; P<0.001). The results from the present study demonstrated that for patients with early metaphase CC, PET/CT scan combined with serum SCC-Ag determination during the follow-up was capable of earlier, more comprehensive and more accurate detection of recurrence/metastatic lesions, which is of high clinical application value.     

Using CT or MRI to assess locoregional spread to determine the radiotherapy target of hypopharyngeal carcinoma

Aim: To identify the locoregional extension of hypopharyngeal carcinoma (HPC), particularly the invasion of the nasopharynx and skull base, and metastasis of level VI and retropharyngeal lymph node (RPLN) by investigating computed tomography (CT) and magnetic resonance (MR) images; together with the radiotherapy target of HPC. Methods: CT and MR images of 186 patients with pathologically confirmed HPC between Aug 2000 and Dec 2010 were analyzed retrospectively. We used the χ² test and logistic regression to analyze local invasion and regional spread and to determine their relationships. Results: Of the 186 patients, there was only one case of invasion of the nasopharynx without skull base involvement. The rate of regional node metastasis was 79%. There was no significant relationship between T stage and lymph node metastasis (P = 0.1). Level IV metastasis (P = 0.001), RPLN metastasis (P = 0.041) and esophageal invasion (P = 0.003) were significantly correlated with level VI metastasis. Primary tumor subsite (P = 0.024), bilateral cervical node metastasis (P < 0.001) and size of cervical nodes (P = 0.01) significantly contributed to the occurrence of RPLN metastasis. Conclusion: The locoregional spread of HPC occurs via certain routes. It is potentially unnecessary to routinely and prophylactically irradiate the nasopharynx and skull base. Patients with early stage HPC should receive bilateral cervical prophylactic irradiation. The decision regarding the administration of prophylactic irradiation to the level VI and RPLN areas should be according to the relative risk factors.     

PET/CT显像在妇科恶性肿瘤术后复发及转移中的临床应用价值

目的:探讨正电子发射断层显像(PET/CT)在诊断妇科恶性肿瘤术后复发与转移中的临床应用价值。方法:回顾性分析2015年1月至2016年12月,在我中心行PET/CT检查的56例妇科恶性肿瘤术后患者的全身PET/CT的显像结果,确诊依据为术后病理结果、血糖类抗原125（CA125）持续升高水平和临床随诊结果,评价PET/CT对妇科恶性肿瘤术后复发、转移的诊断效能。结果:56例患者中,经病理结果、血CA125持续升高水平、临床随诊结果证实,肿瘤复发及转移者25例,没有复发、转移者26例,假阳性者3例,假阴性者2例,PET/CT显像在妇科恶性肿瘤术后复发及转移的灵敏度、特异性、准确率分别为92.6%（25/27）、89.7%（26/29）、91.1%（51/56）;转移灶分为阴道残端、全身淋巴结、远处器官转移,PET/CT显像对各转移灶的灵敏度及特异性分别为87.5%(7/8)和97.9%(47/48)、95.0%（19/20）和91.7%（33/36）、91.3%（21/23）和90.9%（30/33）;PET/CT显像发现全身多部位、多器官转移的6人,改变了临床分期及治疗方案。结论:PET/CT显像对妇科恶性肿瘤术后复发及转移的诊断,具有较高的灵敏度和特异性,对肿瘤术后复发及转移的临床分期及治疗方案的确定具有非常大的指导意义。     

血清白细胞介素18在前列腺癌患者中的临床价值

Objective: To determine serum interleukin-18 (IL-18) levels and their clinical significance in patients with prostate cancer. Methods: Peripheral blood samples were obtained from 38 nonmetastatic and 18 metastatic prostate cancer patients who underwent curative surgery and from 25 healthy volunteers. The serum IL-18 level was determined in each sample with the enzyme-linked immunosorbent assay. Results: The levels of serum IL-18 were increased significantly in prostate cancer patients compared with control subjects (P ＜ 0.05). Serum IL-18 levels were significantly higher in the metastatic patients compared with the nonmetastatic patients (P ＜ 0.01). Patients with bone metastasis had higher serum IL-18 levels compared with patients with liver and lung metastasis (P ＜ 0.01). When the patients were subdivided into groups, it was found that the serum IL-18 levels in patients with T2, T3 and T4 stage were significantly higher than that of T1 stage patients (P ＜ 0.01). Patients with IL-18 levels ≥ 316 pg/mL experienced a significantly lower survival rate compared with the patients who had IL-18levels ＜ 316 pg/mL after undergoing surgery (P ＜ 0.05). The serum IL-18 level was identified as an independent postoperative prognostic factor in multivariate survival analysis using a Cox proportional hazards model (hazard ratio, 4.21; P = 0.02).Conclusion: The serum IL-18 level may be a useful marker in monitoring prostate cancer patients. IL-18 activity in prostate cancer patients with bone metastasis may be more valuable in the follow-up.     

Detection of hematogenous bone metastasis in cervical cancer

BACKGROUND:

In this large‐scale, retrospective study, the authors evaluated the diagnostic performances of computed tomography (CT), magnetic resonance (MR) imaging, and ¹⁸F‐fluorodeoxyglucose‐positron emission tomography (¹⁸F‐FDG–PET) in detecting hematogenous bone metastasis in patients with cervical cancer. The associated risk factors also were analyzed.

METHODS:

Patients with invasive cervical cancer who had both ¹⁸F‐FDG–PET studies and CT or MR imaging studies were selected. Patients who had either International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease or positive lymph node metastasis at the time of primary staging and patients who had suspected recurrent disease were included in the analyses. The diagnostic performances of PET was compared with the performance of CT and MR imaging by using the area under the receiver‐operating‐characteristic curve (AUC). Both univariate and multivariate analyses were applied to assess the risk factors for hematogenous bone metastasis at primary staging.

RESULTS:

PET was more sensitive than CT (P = .004) and was more specific than MR imaging (P = .04). The diagnostic performance of PET was significantly superior to the performance CT (AUC, 0.964 vs 0.662; P < .001) and MR (AUC, 0.966 vs 0.833; P = .033). Both FIGO stage and the extent of lymph node metastases were associated with hematogenous bone metastasis in univariate analysis. However, the extent of lymph node metastases was the only significant risk factor in multivariate analysis (P = .025).

CONCLUSIONS:

The current study demonstrated the superiority of ¹⁸F‐FDG–PET over CT and MR imaging for detecting hematogenous bone metastasis in patients with advanced cervical cancer. Hematogenous bone metastasis in cervical cancer was associated with the extent of lymph node metastases rather than with FIGO stage. Cancer 2009. © 2009 American Cancer Society.     

PET/CT在卵巢癌术后监测复发/转移上的优势:与血清CA125及增强CT比较

目的:探讨18F-脱氧葡萄糖(18F-FDG)PET/CT在早期发现卵巢癌术后复发/转移方面的价值,并与血清CA125检测及增强CT进行比较。方法:回顾性分析过去5年内在我院行卵巢癌二次手术,并在术前均行血清CA125、增强CT、PET/CT检查的患者36例（99个病灶）。分别计算出以患者个体为研究单位时血清CA125及PET/CT检查的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数,并比较二者在监测卵巢癌术后个体复发/转移方面的效能。采用卡方检验或Fisher确切概率法来比较增强CT、PET/CT两种方法诊断卵巢癌术后转移/复发病灶的差异性,并分别计算出以病灶为研究单位时的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数,比较二者在诊断卵巢癌术后复发/转移病灶方面的效能。结果:PET/CT诊断出34/36例复发/转移的患者,而血清CA125以0~35 U/ml为基准时仅诊断出11/36例复发/转移的患者。前者诊断卵巢癌术后复发/转移患者的阳性预测值、灵敏度、准确度明显高于后者（97%、100%、97% vs 91%、32%、33%）。PET/CT与增强CT在诊断卵巢癌术后复发/转移病灶效能方面差异具有统计学意义（P=0.037）。PET/CT能够诊断出78/99个卵巢癌术后复发/转移的真阳性病灶,而增强CT仅能够诊断出70/99个。PET/CT以病灶为研究单位的阳性预测值、阴性预测值、灵敏度、特异度、准确度均比增强CT高（94% vs 89%、62.5% vs 30%、93% vs 83%、67% vs 40%、89% vs 77%）。结论:对于符合二次手术条件的患者,PET/CT诊断卵巢癌术后复发/转移方面的价值要优于血清CA125及增强CT。     

Diagnostic performance of computer tomography,magnetic resonance imaging,and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: Meta‐analysis

We performed a meta‐analysis to compare diagnostic performances of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET or PET/CT), for detection of metastatic lymph nodes in patients with cervical cancer. We searched MEDLINE (PubMed), EMBASE and the Cochrane Review database in December 2007. All articles were independently reviewed and selected by three evaluators. We estimated a summary receiver operating characteristic (sROC) curve. The area under the curve (AUC), Q*, and pooled weighted estimates of sensitivity and specificity for each modality by patient‐based and region‐ or node‐based data analyses and conducted pair‐wise comparisons between modalities using the two‐sample Z‐test. Forty‐one of 768 initially identified studies were included in the meta‐analysis. In a patient‐based data analysis, PET or PET/CT showed the highest pooled sensitivity (82%) and specificity (95%), while CT showed 50% and 92%; and MRI, 56% and 91%, respectively. The AUC (0.9641) and Q* (0.9106) of PET or PET/CT were significantly higher than those of MRI (AUC = 0.8270; Q* = 0.7599), both P < 0.001. In region‐ or node‐based data analysis, sensitivities of CT (52%) and PET or PET/CT (54%) were higher than that of MRI (38%), P < 0.02 and P < 0.001, respectively, while specificities of MRI (97%) and PET or PET/CT (97%) were higher than that of CT (92%), both P < 0.001. The AUC and Q* showed no significant difference among CT, MRI, and PET or PET/CT. PET or PET/CT had an overall higher diagnostic performance than did CT or MRI in detecting metastatic lymph nodes in patients with cervical cancer. (Cancer Sci 2010)     

18F-FDG PET/CT显像在胃癌诊断中的应用

[目的]评价18F-FDG PET/CT显像在胃癌诊断中的应用.[方法]49例经胃镜和病理确诊的胃癌患者进行18F-FDG PET/CT显像,其诊断结果与病理学检查、其他影像学检查及临床随访比较.[结果] 49例患者18F-FDG PET/CT阳性44例,阳性率89.8％;39例有淋巴结转移患者中18F-FDGPET/CT显像发现32例,灵敏度为82.1％(32/39); 12例有远处转移患者中18F-FDG PET/CT显像发现11例,灵敏度91.6％(11/12).[结论]18F-FDG PET/CT显像对胃癌原发灶、淋巴结转移和远处转移具有较高的灵敏度,18F-FDG PET/CT显像在胃癌诊断中具有较高的临床价值.     

Relationship between Expression of CEA,E-cadherin and Liver Metastasis in Colorectal Cancer

Objective  To investigate the expression of E-cadherin and CEA in serum in colorectal carcinoma and their relationship with liver metastasis. Methods  CEA level was measured post-operatively by radioimmunoassay of 60 patients with colorectal cancer. Immunohistochemical analysis was used to evaluate the expression of E-cadherin. Results  In liver metastasis group, 24 patients (24/26, 92.3%) were high level of CEA, but only 9 patients in non-liver metastasis group. The difference is significant (P = 0.004). Expression of E-cadherin significantly correlated with differentiation, but was not associated with T stage or N stage. Liver metastatic rate in negative expression was higher than that in positive expression. And the survival analysis showed that time of liver metastasis was significant different in two groups (P < 0.05). Conclusion  The expression of CEA in serum can be used to predict liver mestatasis of colorectal cancer after operation. E-cadherin, associated with tumor differentiation, is also a hopeful indicator for the prediction of liver metastasis in patients with colorectal cancer.     

Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence

BACKGROUND:

In head and neck cancer (HNC), 3‐month post‐treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of post‐treatment PET/CT surveillance on outcomes is assessed at 12 and 24 months.

METHODS:

A 10‐year retrospective analysis of HNC patients was carried out with long‐term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3‐month scans, 175 had 3‐ and 12‐month scans, and 77 had 3‐, 12‐, and 24‐month scans.

RESULTS:

PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT‐detected and clinically detected recurrences, with similar 3‐year disease‐free survival (41% vs 46%, P = .91) and 3‐year overall survival (60% vs 54%, P = .70) rates. Compared with 3‐month PET/CT, 12‐month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive.

CONCLUSIONS:

HNC patients with negative 3‐month imaging appear to derive limited benefit from subsequent PET/CT surveillance. No survival differences were observed between PET/CT‐detected and clinically detected recurrences, although larger prospective studies are needed for further investigation. Cancer 2013. © 2012 American Cancer Society.     

Value of integrated positron emission tomography revised using a phantom study to evaluate malignancy grade of lung adenocarcinoma

BACKGROUND:

The malignant biological behavior of small‐sized lung adenocarcinomas remains obscure, although understanding this feature is important for selecting appropriate treatment. In the current study, the authors evaluated malignancy grades of small adenocarcinomas using fluorodeoxyglucose‐positron emission tomography/computed tomography (PET/CT) in addition to high‐resolution CT (HRCT) and pathological analysis in a multicenter setting.

METHODS:

A total of 201 patients with clinical T1N0M0 adenocarcinoma underwent PET/CT and HRCT followed by complete surgical resection. Associations between components of bronchioloalveolar carcinoma (BAC) in specimens and maximum standardized uptake values (maxSUV) on PET/CT and ground‐glass opacity (GGO) ratios and tumor disappearance rate (TDR) on HRCT were analyzed, as well as associations between these findings and pathological features of the tumors. Variations in maxSUV among institutions and the underestimations derived from small tumors, which are limitations of PET performed in multicenter studies, were adjusted using a phantom study.

RESULTS:

The maxSUV, BAC ratio, TDR, and GGO ratio (in that order) reflected the grade of tumor invasiveness and lymph node metastasis. The maxSUV and BAC ratio were found to be significant prognostic predictors derived from disease‐free survival curves. Although the BAC ratio was found to be significantly associated with preoperative radiographic parameters, the maxSUV, GGO ratio, and TDR (all P < .0001), the degree of correlation with maxSUV (correlation coefficient [R²] = 0.1699) was much weaker than that reported with the GGO ratio (R² = 0.5860) or TDR (R² = 0.5082).

CONCLUSIONS:

Phantom studies can overcome the difficulties of multicenter studies using PET. A higher maxSUV appears to reflect aggressive malignant behavior in clinical T1N0M0 adenocarcinomas, independent of BAC components. Preoperative PET/CT assessment in addition to HRCT could be used to construct hypotheses for a future clinical study of strategies for the treatment of patients with small lung adenocarcinoma. Cancer 2010. © 2010 American Cancer Society.     

Circulating levels of vascular endothelial growth factor (VEGF), matrix metalloproteinase-3 (MMP-3), and BCL-2 in malignant melanoma

Vascular endothelial growth factor (VEGF) is a critical regulator of angiogenesis that stimulates proliferation, migration, and metastasis of melanoma. In literature, all studies concerning influences of matrix metalloproteinases (MMPs) and antiapoptotic proteins on VEGF-induced angiogenesis in melanoma patients have been performed in tissue scale in melanoma. The objective of this study was to determine the value of circulating serum VEGF and its possible mechanisms of angiogenesis by circulating VEGF, MMP-3, and Bcl-2 in patients with melanoma. Fifty-one patients with cutaneous melanoma pathologically verified at different stages, and eighteen healthy controls were investigated. Serum VEGF, MMP-3, and Bcl-2 levels were quantitatively analyzed by ELISA. The serum VEGF (P = 0.034) and Bcl-2 (P = 0.005) levels were significantly higher in patients with melanoma than in the control group. However, there was no significant difference in the serum MMP-3 level between melanoma patients and controls (P = 0.51). The serum levels of VEGF were significantly influenced only by Breslow thickness (P = 0.045) and mitosis (0.039) and were not positively correlated with the stage of the disease. Among serum parameters, a significant relationship was found only between serum levels of VEGF and MMP-3 (r = 0.32, P = 0.023). In conclusion, our study demonstrates increased concentrations of VEGF and Bcl-2, but not MMP-3, in serum of melanoma patients regardless of the stage of the disease. VEGF may be a potential endothelial cell growth and survival factor. The mechanism of VEGF regulation of angiogenesis may be in part due to enhanced proliferation and survival of endothelial cells by differential expression of antiapoptotic genes and in part by activation of MMPs.     

Non‐small cell lung cancer brain metastasis screening in the era of positron emission tomography‐CT staging: Current practice and outcomes

Introduction

Several clinical guidelines indicate that brain metastasis screening (BMS) should be guided by disease stage in non‐small cell lung cancer (NSCLC). We estimate that screening is performed more broadly in practice, and patients undergo brain imaging at considerable cost with questionable benefit. Our aim was to quantify the use and detection rate of BMS in a contemporary cohort staged with ¹⁸F‐fluorodeoxyglucose positron emission tomography/computed tomography (PET‐CT).

Methods

We conducted a retrospective review of prospectively collected data from three major lung cancer referral centres in Brisbane between January 2011 and December 2015. Patients included had a new diagnosis of NSCLC and had undergone a PET‐CT to stage extra‐cranial disease. BMS was defined as dedicated brain imaging with contrast‐enhanced computed tomography (CE‐CT) or magnetic resonance (MR), in the absence of clinically apparent neurological deficits.

Results

A total of 1751 eligible cases were identified and of these 718 (41%) underwent BMS. The majority had CE‐CT imaging (n = 703). Asymptomatic brain metastases (BM) were detected in 18 patients (2.5%). Of these patients, 12 had concurrent non‐brain metastases. Only six patients (0.8%) had BM alone. The rate of detection increased with N‐stage (P = 0.02) and overall stage (P < 0.001). It was 0.5%, 1%, 1.6% and 7.3% for stage I, II, III and IV respectively. The overall screening rate increased with T‐stage (P = 0.001), N‐Stage (P < 0.001) and overall stage (P < 0.001).

Conclusions

Non‐small cell lung cancer BMS practices remain at odds with published guidelines. The low number of occult BMs detected supports the existing international recommendations. Rationalising BMS would minimise the burden on patients and the health care system.     

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

BACKGROUND:

The objective of this study was to assess whether coregistered whole brain (WB) magnetic resonance imaging‐positron emission tomography (MRI‐PET) would increase the number of correctly upstaged patients compared with WB PET‐computed tomography (PET‐CT) plus dedicated brain MRI in patients with nonsmall cell lung cancer (NSCLC).

METHODS:

From January 2010 through November 2011, patients with NSCLC who had resectable disease based on conventional staging were assigned randomly either to coregistered MRI‐PET or WB PET‐CT plus brain MRI (ClinicalTrials.gov trial NCT01065415). The primary endpoint was correct upstaging (the identification of lesions with higher tumor, lymph node, or metastasis classification, verified with biopsy or other diagnostic test) to have the advantage of avoiding unnecessary thoracotomy, to determine appropriate treatment, and to accurately predict patient prognosis. The secondary endpoints were over staging and under staging compared with pathologic staging.

RESULTS:

Lung cancer was correctly upstaged in 37 of 143 patients (25.9%) in the MRI‐PET group and in 26 of 120 patients (21.7%) in the PET‐CT plus brain MRI group (4.2% difference; 95% confidence interval, ?6.1% to 14.5%; P = .426). Lung cancer was over staged in 26 of 143 patients (18.2%) in the MRI‐PET group and in 7 of 120 patients (5.8%) in the PET‐CT plus brain MRI group (12.4% difference; 95% confidence interval, 4.8%‐20%; P = .003), whereas lung cancer was under staged in 18 of 143 patients (12.6%) and in 28 of 120 patients (23.3%), respectively (?10.7% difference; 95% confidence interval, ?20.1% to ?1.4%; P = .022).

CONCLUSIONS:

Although both staging tools allowed greater than 20% correct upstaging compared with conventional staging methods, coregistered MRI‐PET did not appear to help identify significantly more correctly upstaged patients than PET‐CT plus brain MRI in patients with NSCLC. Cancer 2013. © 2013 American Cancer Society.     

P53、C-erbB-2和VEGF在非小细胞肺癌中的表达及其临床意义

Objective: To investigate the expressions and the clinical significance of P53, C-erbB-2 and vascular endothelial growth factor(VEGF)in non-small cell lung cancer(NSCLC).Methods: 121 specimens of NSCLC were examined for P53, C-erbB-2 and VEGF by immunohistochemical staining.Results: The positive rates of P53, C-erbB-2 and VEGF in the carcinomatous tissue were 43%, 39% and 31% respectively.P53 gene protein expression in lung cancer was significantly related to histological type and P-TNM staging of lung cancer patients(P＜0.05), and was not associated with the sex, age, the size of primary cancer, lymph node metastasis and cell differentiation(P＞0.05).C-erbB-2 gene protein expression in lung cancer was closely related to histological type and cell differentiation(P＜0.05), and was not associated with the sex, age, the size of primary cancer, lymph node metastasis and P-TNM staging of lung cancer patients(P＞0.05).VEGF in lung cancer was only closely related to cell differentiation(P＜0.05), and was not associated with the sex, age, the size of primary cancer, lymph node metastasis, histological type and P-TNM staging of lung cancer patients(P＞0.05).Conclusion: It is possible for P53, C-erbB-2 and VEGF to play an important role in the oncogenesis and development of non-small cell lung cancer.     

The diagnostic and prognostic utility of positron emission tomography/computed tomography‐based follow‐up after radiotherapy for head and neck cancer

BACKGROUND:

The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow‐up program incorporating serial ¹⁸F?fluorodeoxyglucose?positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer.

METHODS:

A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow?up, 21 months).

RESULTS:

The sensitivity, specificity, and positive and negative predictive values of PET/CT‐based follow‐up for detecting locoregional recurrence were 92%, 82%, 42%, and 98%, respectively. Corresponding values for distant metastases or second primary tumors were 93%, 96%, 81%, and 98%, respectively. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2‐year progression‐free survival and 2‐year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively).

CONCLUSIONS:

Although post‐therapy follow‐up using PET/CT is reportedly associated with a high false‐positive rate in the irradiated head and neck, PET/CT appears to be a highly sensitive technique for the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value. Cancer 2009. © 2009 American Cancer Society.     

Correlation of the Appearances of DSA with VEGF Expression and Its Clinical Significance in Patients with Primary Hepatocellular Carcinoma

目的探讨原发性肝癌患者的数字减影血管造影(DSA)表现和血管内皮细胞生长因子(VEGF)水平之间的关系。方法对24例原发性肝癌患者30次进行DSA的同时选用酶联免疫吸附定量法检测血清的VEGF水平。结果24例HCC血管造影中,18例有肝动脉肿瘤染色,瘤区肝动脉染色15例为多血供,3例为少血供;4例仅表现为门静脉供血; 1例为肠系膜上动脉供血,且合并大量门静脉瘘;另1例肿瘤无血供,HCC组血清VEGF表达水平(194．5±14．2)ng/L与对照组(132．4±47．9)比较,有显著性差异(P<0．01)。结论肝癌病灶血供丰富或伴有动静脉瘘形成者,血循环中VEGF浓度明显增高,且和肝内播散、肝癌复发及转移呈正相关。