Prognostic value of initial fluorodeoxyglucose-PET in esophageal cancer: a prospective study

OBJECTIVES: Esophageal cancer outcome greatly depends on the pathological stage. Our objectives were to assess prognosis on the basis of the initial fluorodeoxyglucose (FDG)-PET scan, focusing on the correlation between overall survival and FDG uptake in the primary, as well as the presence of FDG-positive lymph nodes or distant metastases. METHODS: Fifty-two esophageal cancer patients undergoing FDG-PET as part of initial routine staging procedure before treatment were included. The maximum standardized uptake value (SUV max) was determined in each primary lesion and the number of abnormalities including primary, lymph nodes, or distant metastases was recorded. Correlation with overall survival was performed using Kaplan-Meier method and Cox regression analysis was used to assess the prognostic value of PET parameters. RESULTS: Half of the patients were planned for initial curative surgery (52%). Using univariate survival analysis, either surgery, SUV max >9, two or more PET abnormalities or the presence of FDG-positive nodes were significant overall survival prognostic predictors. After multivariate analysis, only SUV max >9 and FDG-positive lymph nodes were found as independent predictors of poor outcome. CONCLUSION: In this prospective study, FDG-PET was found to provide prognostic information supporting a new indication for initial FDG-PET examination in esophageal cancer.     

肾功能对于食管癌患者~(18)F-FDGPET-CT标准化摄取值的影响

目的:分析肾功能改变对于食管癌患者和健康体检者18 F-FDG PET-CT标准化摄取值(standard uptake value,SUV)的影响。方法:行18F-FDG PET-CT检查的64例食管癌患者分别记录臀大肌和食管癌病灶的SUV(肌SUV和食管癌SUV);44例健康体检者分别记录臀大肌和食管的SUV(肌SUV和食管SUV)。食管癌患者和体检者均根据血Cr水平分别分为肾功能正常组和肾功能减低组。分别比较食管癌2组在肌SUV及食管癌SUV方面,体检者2组在肌SUV及食管SUV方面,差异是否有统计学意义。结果:食管癌患者中肾功能正常组与肾功能减低组的肌SUV(0.627±0.130、0.722±0.137)差异有统计学意义;体检者中肾功能正常组与肾功能减低组的肌SUV(0.654±0.145、0.794±0.229)、食管SUV(0.764±0.396、1.044±0.499),差异均有统计学意义。而食管癌患者中肾功能正常组与肾功能减低组的食管癌SUV(7.189±2.235、7.559±2.609)差异无统计学意义。结论:肾功能损害主要影响18F-FDG PET-CT人体本底SUV,对于食管癌病灶的SUV无显著影响。     

18F-FDG PET对原发性食管癌和复发性食管癌的诊断价值

食管癌的预后较差,手术的致死率和致残率均较高,术前正确分期对确定治疗方案显得尤为重要.PET是继CT、MRI、食管镜等常规检查的有益补充.受分辨率的影响,PET较难确定肿瘤的局部浸润程度,在局部淋巴结转移方面其价值有待于进一步的研究,但对远处转移灶的诊断明显优于CT、MRI等常规检查,诊断复发性食管癌准确率较高,能有效鉴别手术疤痕和复发,有效评价放化疗的疗效.结合传统影像学检查,18F-FDG能较为准确地进行术前分期,纠正不正确的治疗方案,改善食管癌的预后.     

Does the association of 18F-FDG uptake intensity and lesion topography reveal histological phenotype and tumor differentiation in esophageal cancer?

In daily clinical practice, the esophageal squamous cell cancer (ESCC) is considered to be more (18)F-FDG avid than adenocarcinoma (EAD). To date, the few studies concerning the existence of a real metabolic difference based on esophageal cancer (EC) histology, show divergent and not definitive results. A retrospective analysis of (18)F-FDG PET/CT of 87 patients with ESCC and EAD was performed to investigate the role played by both histopathological subtype and tumor differentiation in the characterization of glucose metabolic profile of EC. Esophageal squamous cell cancer was well differentiated (WD) in 42 cases and poorly differentiated (PD) in 12 patients. Twenty-one of the 33 patients had WD EAD, while 12 had a PD EAD. The (18)F-FDG maximal standardized uptake value (SUV(max)) was determined for all lesions and used for inter and intra-group comparison. In ESCC, the SUV(max) ranged from 4 to 31 with a mean value of 16±6. In EAD, the SUV(max) ranged from 2 to 25 with a mean value of 10±6. A statistically significant difference (P<0.0001) was found between ESCC and EAD. According to histological classification and tumor differentiation, we obtained the following results: a) the SUV(max) values of WD ESCC and WD EAD were 17±5 (range: 7-31) and 7±3 (range: 2-12) respectively (P<0.00001), b) the SUV(max) values of PD ESCC and PD EAD were 11±4 (range: 4-19) and 17±6 (range: 7-25) respectively (P<0.05). Moreover, a statistically significant difference of SUV(max) values was found between WD and PD ESCC (P<0.005) as well as between WD and PD differentiated EAD (P<0.0001). In order to predict tumor histology (ESCC, EAD) from both SUV(max) and lesion location, a multivariate discriminant analysis was performed on the whole population with a resulting diagnostic accuracy equal to 82% (P<0.00001). In conclusion, we provide additional arguments about (18)F-FDG uptake difference between ESCC and EAD as well as between poorly and well-differentiated forms of both EC histological subtypes.     

晚期乳腺癌18F-FDG PET-CT显像标准摄取值与预后的相关性

目的 探讨晚期乳腺癌18 F-FDG PET-CT显像标准摄取值与预后的相关性.方法 选择68例晚期乳腺癌患者,记录诊断时PET-CT的SUV值,均给予全身静脉化疗,以SUV值8为分界点,将本组患者分为两组,随访5年,观察SUV值与5年生存率的关系.结果 本组观察的68例患者,SUV值越小,生存期相对越长,反之,生存期则相对较短.结论 18F-FDG PET-CT显像标准摄取值(SUV值)对乳腺癌的预后有一定价值,值得临床进一步研究.     

18F-FDG uptake as a biologic prognostic factor for recurrence in patients with surgically resected non-small cell lung cancer.

Among patients with resected non-small cell lung cancer (NSCLC), approximately 50% present with a recurrent tumor. The clinical or pathologic TNM staging does not always provide a satisfactory explanation for differences in relapse and survival. Thus, it is of major importance to be able to predict these relapses and to prevent them with an active chemotherapy or radiotherapy program (or both). 18F-FDG uptake on PET could be of prognostic significance in patients with resected NSCLC. The goal of this study was to determine whether the level of metabolic activity observed with 18F-FDG uptake correlates with the probability of postoperative recurrence in patients with NSCLC. METHODS: Fifty-seven patients with NSCLC were examined with 18F-FDG PET. For semiquantitative analysis, standardized uptake values (SUVs) were calculated. Patients were classified into high-SUV (> 5.0) and low-SUV (< or = 5.0) groups. All patients underwent thoracotomy within 4 wk after the 18F-FDG PET study. Tumor 18F-FDG uptake (SUV), pathologic stage, and lesion size were analyzed for their possible association with disease-free survival. RESULTS: Forty-six patients had pathologic stage I NSCLC and 11 had pathologic stage II or stage III NSCLC. In a univariate analysis, patients with an SUV of < or = 5 had a much better disease-free survival than did patients with an SUV of > 5 (P < 0.0001). In patients with pathologic stage I and stage IA NSCLC, the SUV was also correlated with disease-free survival (P < 0.0001 and P = 0.0012, respectively). Patients with pathologic stage I disease had an expected 5-y disease-free survival rate of 88% if the SUV was < or = 5 and a survival rate of < or = 17% if the SUV was > 5. A multivariate Cox analysis identified the SUV as the most significant independent factor for disease-free survival. CONCLUSION: We conclude that the 18F-FDG uptake in primary NSCLC determined by PET has a significant independent postoperative prognostic value for recurrence, especially in patients with pathologic stage I NSCLC. 18F-FDG uptake was superior to pathologic stage in predicting relapse of patients with NSCLC.     

Prognostic value of [<Superscript>18</Superscript>F]FDG-PET imaging in small cell lung cancer

Positron emission tomography (PET) utilizing fluorine-18 fluorodeoxyglucose (FDG) has been used in the evaluation of non-small cell lung cancer (NSCLC). Recently its use in the staging of small cell lung cancer (SCLC) has been reported. However, the prognostic value of FDG-PET imaging in SCLC has not been studied. We performed a retrospective analysis to assess this, with the following hypotheses: (1) PET-positive patients would have a less favorable prognosis than PET-negative patients and (2) a high standardized uptake value (SUV) would be associated with a poor prognosis. Retrospective review of a mixed population of treated and untreated patients imaged between 1995 and 2000 was performed. Results of 62 scans in 46 patients were analyzed. There were 8 untreated and 38 treated patients. Findings were correlated with pathology, computed tomography/magnetic resonance imaging and clinical data. The sensitivity of PET scanning was 100% with pathological correlation. The prognostic value of a positive PET study was determined. Overall survival in PET-positive cases was significantly worse than that in PET-negative cases ( P=0.0108). Correlation of SUV(max) with survival showed a significant negative correlation ( P=0.0021). In the eight untreated patients, scans were strongly positive and in all cases the scan results concurred with the final clinical stage assigned on the basis of conventional methods. We conclude that FDG-PET imaging provides prognostic information in treated patients. A positive study and a high SUV(max) are significantly associated with poor survival. Additionally, FDG-PET may be helpful in staging and follow-up.     

Comparison of 18F-FLT PET and 18F-FDG PET in esophageal cancer.

18F-FDG PET has gained acceptance for staging of esophageal cancer. However, FDG is not tumor specific and false-positive results may occur by accumulation of FDG in benign tissue. The tracer 18F-fluoro-3'-deoxy-3'-L-fluorothymidine (18F-FLT) might not have these drawbacks. The aim of this study was to investigate the feasibility of 18F-FLT PET for the detection and staging of esophageal cancer and to compare 18F-FLT PET with 18F-FDG PET. Furthermore, the correlation between 18F-FLT and 18F-FDG uptake and proliferation of the tumor was investigated. METHODS: Ten patients with biopsy-proven cancer of the esophagus or gastroesophageal junction were staged with CT, endoscopic ultrasonography, and ultrasound of the neck. In addition, all patients underwent a whole-body 18F-FLT PET and 18F-FDG PET. Standardized uptake values were compared with proliferation expressed by Ki-67 positivity. RESULTS: 18F-FDG PET was able to detect all esophageal cancers, whereas 18F-FLT PET visualized the tumor in 8 of 10 patients. Both 18F-FDG PET and 18F-FLT PET detected lymph node metastases in 2 of 8 patients. 18F-FDG PET detected 1 cervical lymph node that was missed on 18F-FLT PET, whereas 18F-FDG PET showed uptake in benign lesions in 2 patients. The uptake of 18F-FDG (median standardized uptake value [SUV(mean)], 6.0) was significantly higher than 18F-FLT (median SUV(mean), 3.4). Neither 18F-FDG maximum SUV (SUV(max)) nor 18F-FLT SUV(max) correlated with Ki-67 expression in the linear regression analysis. CONCLUSION: In this study, uptake of 18F-FDG in esophageal cancer is significantly higher compared with 18F-FLT uptake. 18F-FLT scans show more false-negative findings and fewer false-positive findings than do 18F-FDG scans. Uptake of 18F-FDG or 18F-FLT did not correlate with proliferation.     

Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability.

OBJECTIVE. Our objective was to determine if CT or MR imaging findings could be used to accurately predict resectability in patients with biopsy-proved malignant pleural mesotheliomas. SUBJECTS AND METHODS. CT and MR findings in 41 consecutive patients with malignant mesotheliomas who were referred to the thoracic surgery clinic for extrapleural pneumonectomy were studied by thoracic radiologists before surgery. Review of radiologic studies focused on local invasion of three separate regions: the diaphragm, chest wall, and mediastinum. Results of all imaging examinations were carefully correlated with intraoperative, gross, and microscopic pathologic findings. RESULTS. After radiologic and clinical evaluation, 34 patients (83%) had thoracotomy; 24 of these had tumors that were resectable. The sensitivity was high (> 90%) for both CT and MR in each region. Specificity, however, was low, probably because of the small number of patients with unresectable tumors. CONCLUSION. CT and MR provided similar information on resectability in most cases. Sensitivity was high for both procedures. Because CT is more widely available and used, we suggest it as the initial study when determining resectability. In difficult cases, important complementary anatomic information can be derived from MR images obtained before surgical intervention.     

Prognostic aspects of 18F-FDG PET kinetics in patients with metastatic colorectal carcinoma receiving FOLFOX chemotherapy.

We evaluated quantitative measurement series (MS) with 18F-FDG and PET and compared different quantification methods for prediction of individual survival in patients with metastatic colorectal cancer receiving chemotherapy with 5-fluorouracil, folinic acid, and oxaliplatin (FOLFOX). METHODS: The study comprised 25 patients. All patients were examined before the onset of FOLFOX therapy and after completion of the first and fourth cycles. SUV, fractal dimension (FD), a 2-compartment model with computation of k1, k2, k3, and k4, and vascular fraction (VB) were used for data evaluation. Survival data served as a reference for the PET data. Discriminant analysis (DA), regression, and best-subset analysis were applied to the data. RESULTS: Twenty of 25 patients died up to 801 d after the first PET study. A cutoff of 1 y (364 d) was used to classify the patients into 2 a priori groups, namely the short- and long-term survival groups. DA was used to predict the 2 categories using SUV and kinetic parameters of 18F-FDG metabolism as predictor variables. SUV provided a correct classification rate (CCR) ranging from 62% to 69%. SUV of the third MS resulted in a CCR of 69% as a single parameter. The best results were yielded by the use of kinetic parameters (k1, k3, VB, and FD) as predictor variables. CCR was 78% using kinetic 18F-FDG parameters of the first and third MS, in comparison with 69% for the corresponding SUVs. A multiple linear regression model was applied to the data to assess the relationship between individual survival and the PET data. The best-subset method revealed a correlation coefficient of 0.850 for the kinetic parameters of the first (k3, k4, VB, and FD) and third (k1, k2, k4, and VB) MS. CONCLUSION: The combination of kinetic parameters of the first and the third MS is acceptable for classification into a short or long survival class. Furthermore, even an individual prognosis of survival can be achieved using kinetic 18F-FDG parameters of the first and third MS.     

Dual-phase 18F-fluoro-2-deoxy-d-glucose positron emission tomography as a prognostic parameter in patients with pancreatic cancer

Purpose 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.Methods 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.Results 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).Conclusion 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.     

18F-FDG PET-CT对周围型肺癌的诊断价值研究

目的 探讨PET-CT对周围型肺癌的诊断价值.方法 回顾性分析70例经病理证实的周围型肺癌患者的PET-CT影像资料,分析病灶的标准化摄取值(SUV)及其形态学表现.结果 70例周围型肺癌患者中,鳞癌患者32例、腺癌患者25例、小细胞肺癌患者8例、腺鳞癌患者3例、大细胞肺癌2例.平均SUV=4.94±1.53,其中,66例患者的PET影像结果可见18F-FDG高浓聚,SUV≥2.5;另外4例的SUV＜2.5.SUV与肿块大小呈显著相关性.结论 周围型肺癌大多具有较特殊的PET-CT影像学表现.PET-CT对周围型肺癌的诊断及鉴别诊断有较好的效能.SUV结合形态学分析有助于病灶的鉴别诊断.     

Diagnostic and prognostic value of 18F-FDG PET/CT for patients with suspected recurrence from squamous cell carcinoma of the esophagus.

Patients with esophageal squamous cell carcinoma (ESCC) are commonly at high risk of recurrence within 2 y after initial treatment. The aim of this study was to evaluate the role of 18F-FDG PET/CT in patients with possibly recurrent ESCC who underwent definitive treatment. METHODS: Fifty-six patients with previously treated ESCC underwent PET/CT scans. The PET/CT findings were validated by histopathology or clinical follow-up of at least 6 mo. The sensitivity, specificity, and accuracy of PET/CT for detecting recurrence were calculated. Comparison of the standardized uptake value (SUV) was performed between patients grouped according to their status at the last follow-up (relapsed or relapse-free, alive or dead). The overall survival rates were estimated by the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate independent prognostic variables for both univariate and multivariate survival analysis. RESULTS: Forty-five (80.4%) patients had recurrence in 72 (66.1%) malignant sites. On PET/CT, there were 9 false-positive and 5 false-negative results. The overall sensitivity, specificity, and accuracy of PET/CT for detecting recurrence at all sites were 93.1% (67/72), 75.7% (28/37), and 87.2% (95/109), respectively. PET/CT was highly sensitive, specific, and accurate at regional and distant sites. At local sites, sensitivity was high, but specificity was lower (50%) because of a high incidence of false-positive findings. Patients who were confirmed with recurrence or who had died at the last follow-up had higher SUVs (P = 0.027 and <0.001, respectively). In multivariate survival analysis, therapeutic modality (hazard ratio = 0.437; P = 0.044), SUV (hazard ratio = 1.071; P = 0.029), and disease status on PET/CT (hazard ratio = 2.430; P = 0.045) were independent significant prognostic predictors for overall survival. The Kaplan-Meier survival curves indicated poor prognostic outcome in subgroup patients with higher SUVs or systemic disease on PET/CT. CONCLUSION: 18F-FDG PET/CT is highly effective for detecting recurrent ESCC. The relatively low specificity at local sites is associated primarily with a high rate of false-positive interpretations at anastomoses. PET/CT can also provide noninvasive and independent prognostic information using SUV and recurrent disease pattern on PET/CT images for previously treated ESCC.     

Determination of the prognostic value of [(18)F]fluorodeoxyglucose uptake by using positron emission tomography in patients with non-small cell lung cancer

The aim of this study was to determine whether quantitative information obtained from [(18)F]fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) has a prognostic significance for patients with non-small cell lung cancer (NSCLC). We investigated (18)F-FDG PET imaging of 73 patients with NSCLC. The maximum standardized uptake value (SUV(max)) was significantly different between the histopathological types of tumour (squamous cell carcinoma (n=37, 12.4+/-5.1), adenocarcinoma (n=30, 8.2+/-5.8), bronchioloalveolar carcinoma (n=4, 2.6+/-1.7), <0.01). In the univariate analysis of all patients, staging (P=0.0001), tumour cell type (P=0.013), and a SUV(max) greater than 7 (P=0.0011) was correlated with survival. However, a multivariate analysis identified staging and SUV(max) greater than 7 were affected survival adversely. The mortality rate of patients with group I disease (stage I to stage IIIA) was 5.8 times lower than that of patients with group II disease (stage IIIB to stage IV). Patients with a high SUV(max) (> or =7) had a 6.3 times higher mortality than those with a low SUV(max)(<7). By multivariate analysis of patients with squamous cell carcinoma, only grouping affected survival (P=0.008, relative risk=4.3). In the case of adenocarcinoma, the SUV(max) (>10) correlated exclusively with poorer survival (P=0.031, relative risk=11.152). (18)F-FDG uptake correlated with survival in NSCLC. Especially in adenocarcinomas, the SUV(max) was complementary to other known prognostic factors.     

Tumour length measured on PET-CT predicts the most appropriate stage-dependent therapeutic approach in oesophageal cancer

To compare the accuracy of determining the most appropriate treatment approach based on a visual analysis on combined PET-CT, based on a visual analysis on PET (reviewed side-by-side with CT) and based on tumour length measurements (on PET and PET-CT). Tumour length, SUV, and the length-SUV index (length × SUV) were assessed (on PET and PET-CT) in benign oesophageal lesions (reflux oesophagitis; n = 29), in potentially curable stages of oesophageal cancer (Tis; T1-T3NxM0; curable group; n = 52), and in stages of oesophageal cancer best treated with palliative therapy (T4NxMx; TxNxM1; palliative group; n = 30). All lesions were histopathologically proven. Based on a visual analysis, PET-CT (sensitivity: 77%;specificity: 96%) was more accurate than PET (sensitivity: 67%; specificity: 89%) in assessing the appropriate treatment (curative vs. palliative). The length-SUV index was the most accurate quantitative parameter to distinguish palliative from curable stages (sensitivity: 93%; specificity: 90%) and to predict survival. The highest overall accuracy was reached when combining the results of the quantitative (length-SUV index) analysis with those of the qualitative (visual) analysis (sensitivity: 93%; specificity: 96%). Moreover, neither tumour length nor SUV can be used to distinguish reflux oesophagitis from early malignant lesions (T1 stage). Tumour length measured with PET-CT or PET is associated with stage and overall survival of oesophageal cancer and helps to guide the appropriate treatment approach.     

Prognostic value of pretreatment tumor-to-blood standardized uptake ratio (SUR) in rectal cancer

Annals of Nuclear Medicine - The prognostic value of SUV on pretreatment F-18 FDG PET/CT imaging in patients with rectal cancer is a matter of debate. SUR is of prognostic value for survival in...     

Prognostic value of the standardized uptake value for 18F-fluorodeoxyglucose in patients with stage IIIB melanoma

Purpose

FDG PET/CT is an excellent tool to detect melanoma metastases and also allows quantification of FDG uptake using standardized uptake value (SUV). The aim of this study was to prospectively investigate the potential prognostic value of SUV for disease-free survival (DFS) and disease-specific survival (DSS) for patients with stage IIIB melanoma.

Methods

From November 2003 to March 2008, all consecutive patients were included in the present study. Inclusion criteria were: palpable, histology- or cytology-proven lymph node metastases of melanoma, and referred to the University Medical Centre Groningen for FDG PET and CT examination. Patients without distant metastases were evaluated. Multivariable survival analysis was performed to determine whether SUV was associated with DFS and DSS (Cox proportional hazard analysis).

Results

In 80 patients (without distant metastases, 65?%) SUV could be measured. Overall 5-year DFS was 41?% (95% CI 26–56?%) and 24?% (95% CI 12–38?%) in patients with a low and high SUVmean (p?=?0.02), respectively. Overall 5-year DSS was 48?% (95% CI 31–62?%) and 30?% (95% CI 17–45?%) in patients with a low and high SUVmean (p?=?0.04), respectively. In the multivariable analysis, SUVmean was associated with DFS (hazard ratio 1.7; p?=?0.048), but was not associated with DSS (hazard ratio 1.6; p?=?0.1). The number of positive nodes, extranodal growth and gender were also associated with survival.

Conclusion

FDG uptake in clinically overt nodal melanoma metastases is inversely associated with DFS. Univariate analysis showed an association with DSS. However, after adjustment for potential confounders this association was no longer significant. If these findings are confirmed in larger studies, SUVmean could potentially be used (in addition to the number of positive nodes, tumour size and extranodal growth) as a factor in deciding on adjuvant systemic treatment.     

Prognostic value of FDG PET imaging in malignant pleural mesothelioma.

Despite several attempts at treating malignant pleural mesothelioma with various modalities, mortality remains high, with median survival between 12 and 18 mo. This disease may have a highly variable clinical course, with occasional long-term survivors. The purpose of this study was to assess whether tumor metabolic activity, as assessed by fluorodeoxyglucose (FDG) PET imaging, correlates inversely with survival. METHODS: Twenty-eight patients with suspected mesothelioma underwent FDG PET scanning between September 1995 and May 1997. A diagnosis of mesothelioma was confirmed in 22. Fully corrected scans with attenuation correction of the entire chest were available in 17 patients with sufficient follow-up for survival analysis. Standardized uptake values (SUVs) were determined from the most active tumor site in each patient. RESULTS: Seven patients died during follow-up, at a median period of 5.3 mo after FDG PET scanning. Follow-up information was available on the remaining 10 patients for a median period of 15.6 mo after the PET study. The mean SUV of the deceased patients was 6.6+/-2.9, compared with 3.2+/-1.6 among the combined survivors. The deceased patients had tumor SUVs that were highly correlated with duration of survival after the PET study (r = 0.87, P < 0.05). The cumulative survival estimate by the Kaplan-Meier product limit method was 0.17 at 12 mo for the patients with tumor SUVs greater than the median value and 0.86 for those with lower SUVs. The survival distribution of the high SUV group showed significantly shorter survivals compared with the low SUV group (P < 0.01). CONCLUSION: Patients with highly active mesotheliomas on FDG PET imaging have a poor prognosis. High FDG uptake in these tumors indicates shorter patient survival.     

L-1-11C-tyrosine PET in patients with laryngeal carcinomas: comparison of standardized uptake value and protein synthesis rate.

PET with L-1-(11)C-tyrosine (TYR) can measure and quantify increased protein synthesis in tumor tissue in vivo. For quantification of the protein synthesis rate (PSR), arterial cannulation with repeated blood sampling to obtain the plasma input function and a dynamic TYR PET study to calculate a time-activity curve are necessary. In most PET studies the standardized uptake value (SUV) method is used to quantify tumor activity. The SUV can be calculated without repeated arterial blood sampling and prolonged scanning time, as required for determination of the PSR. The relationship between PSR and SUV is largely unknown and different factors can cause wide variability in the SUV. Therefore, the comparison of the absolute quantification method (PSR) with the SUV method is obligatory to determine the possible use of noninvasive PET in head and neck oncology. METHODS: Twenty-four patients with proven squamous cell carcinomas of the larynx (T1-T4) were studied using dynamic TYR PET. The PSRs of tumor and nontumor (background) regions were determined. Four different methods were used to calculate the SUV: uncorrected SUV (SUV(BW)); and SUVs corrected for body surface area (SUV(BSA)), for lean body mass (SUV(LBM)), and for the Quetelet index (SUV(QI)). Correlations between PSR values and SUVs were calculated. RESULTS: The PSR of all tumors was significantly higher (P < 0.001) than the PSR of nontumor tissue. The correlations of SUV(BW), SUV(BSA), SUV(LBM), and SUV(QI) with the quantitative values of the PSR were high (r = 0.84-0.90). The best correlation was observed with the SUV based on the LBM (SUV(LBM)). CONCLUSION: High correlation between the quantitative values (PSR) and the SUVs offers the possibility to use noninvasive TYR PET for detection and reliable quantification of primary head and neck tumors.     

食管癌临床分期对三维适形放射治疗预后的影响

目的 分析食管癌三维适形放射治疗的预后影响因素,评价食管癌临床分期对判断预后的价值。方法回顾性分析资料完整的81例接受三维适形放疗的食管癌患者,对可能影响预后的因素进行多因素分析,并比较肿瘤局部T分期、N分期和临床分期与预后的关系。结果全组患者1、2、3、4年总生存率分别为67.9%、45.7%、40.5%和30.9%,1、2、3、4年局部控制率分别为83.0%、76.1%、73.9%和69.8%。放疗前X射线病变长度、病变局部T分期、临床分期、食管GTVD₉₅为影响患者总生存率的独立预后因素。T₁+T₂期与T₃、T₄期比较,临床Ⅰ+Ⅱ与临床Ⅲ、Ⅳ期比较,总生存率、局部控制率、无远处转移生存率及无瘤进展生存率的差异均有统计学意义。N₀期与N₁、N₂期比较,除局部控制率外,总生存率、无远处转移生存率及无瘤进展生存率差异均有统计学意义。临床Ⅲ期与Ⅳ期之间除局部控制率差异无统计学意义外(χ²=2.03,P=0.155),总生存率、无远处转移生存率及无瘤进展生存率比较差异均有统计学意义(χ²值分别为5.38、4.26、3.96,P值分别为0.020、0.039、0.045 )。结论食管癌临床分期的四分类法是非手术治疗食管癌比较理想的分期方法,能较好地预示放射治疗的预后。