SNM 2009:FDG/PET/CT在偵測卵巢癌再發上可能比CA-125更好


  June 17, 2009(多倫多)-一項發表在核子醫學學會第56屆年會的研究結果顯示,相較於標準血清標記,氟化去氧葡萄糖(FDG)正子攝影斷層掃描/電腦斷層掃描(PET/CT),在偵測卵巢癌再發上可以提供更準確的評估。
  
  發表者、馬里蘭巴爾的摩約翰霍普金斯大學院放射科核子醫學部門的第二年住院醫師Mehrbod Javadi表示,卵巢癌是女性第五常見的癌症。
  
  Javadi醫師表示,對罹患末期卵巢癌女性而言,這是非常令人耗弱的疾病,這個疾病可能被重複診斷出來好幾次。
  
  他解釋,CA-125過去經常被用於追蹤病患反應。PDG-PET/CT代表一個全新、偵測病患疾病是否再發以及評估再發的工具。我們想要看這之間的差異,其合併價值,以及比較PDG-PET/CT與CA-125的預後價值。
  
  Javadi醫師與其同事們回溯性地追蹤30位診斷為第III/VI期卵巢癌的患者,他們罹患的都是會分泌CA-125的腫瘤,這些病患共接受157件PET/CT掃描,以及一連串的CA-125篩檢。他解釋,根據所有可以取得的臨床數據,包括之後的顯影檢驗,來追蹤病理與臨床預後。
  
  【嚴謹的評估】
  Javadi醫師表示,如果某人的PET檢驗為陰性,接著在三個月後一次的核磁共振檢驗為陽性,且之後PET掃描也呈陽性,則一開始的PET檢驗將被認為是偽陰性。在評估PET/CT時,我們想要盡可能地嚴謹。不論那時候是否為顯微鏡下的疾病,我們仍然將它視為是偽陰性。
  
  Javadi醫師指出,這項研究的平均追蹤時間為5年。
  
  這項研究發現,PET/CT在偵測再發上的敏感度為90%,比CA-125使用Bristow(58%)、婦科癌症團隊(GCIC;26%)標準高。在專一性方面,PET的專一性為91%,相較於Bristow的89%與GCIC的100%。PET、Brisow與GCIC的陽性預測值分別為91%、85%與100%。PET、Bristow與GCIC的陰性預測值分別為90%、67%與57%。
  
  研究者的結論是,治療後或是再發後成功治療PET陰性與免於疾病再發存活平均增加1.5年有關。
  
  Javadi醫師表示,相較於治療後PET仍呈陽性,治療後PET呈陰性預測免於疾病再發存活時間較長。我們在CA-125分析上並未看到這樣的差異。
  
  Javadi醫師附帶表示,下一步是要以預先設定的計畫及追蹤時間進行前瞻性隨機分派研究。
  
  洛杉磯南加大放射學教授、同時也是核子醫學學會前任理事長Peter Conti醫師表示,我們確實看到PET科技在卵巢癌上的重要角色。
  
  Conti醫師向Medscape放射學表示,血液標記檢驗,如CA-125,告訴你那裡有異常,但是它卻沒有告訴你異常的位置在哪裡。除此之外,並非所有癌症都是呈CA-125陽性。即使這在篩檢時是很有用的,但這僅對於試驗前表現CA-125的特定族群有用。
  
  根據Conti醫師指出,這項研究提出了合併來自血液標記、造影、與臨床檢驗數據的重要性。Conti醫師表示,結合所有這些資訊比單一看某個血液標記來得強大。
  
  這項研究由Javadi醫師獨立進行。Conti醫師表示沒有相關資金上的往來。
  

SNM 2009: FDG-PET/CT May Be Superior to CA-125 in Detecting Ovarian Cancer Recurrence

By Louise Gagnon
Medscape Medical News

June 17, 2009 (Toronto, Ontario) — Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can provide a more precise assessment of recurrence and outcome in ovarian cancer than the standard serum tumor marker, a study presented here at the Society of Nuclear Medicine 56th Annual Meeting has found.

Ovarian cancer is the fifth most common cancer in women, noted presenter Mehrbod Javadi, MD, a second-year resident in the Division of Nuclear Medicine, Department of Radiology, at John Hopkins University in Baltimore, Maryland.

"It is a very debilitating disease for patients who have late-stage ovarian cancer, which is how it is diagnosed many times," said Dr. Javadi.

"CA-125 is what has been used in the past to monitor patients. FDG-PET/CT represents a new and innovative way to look at patients and assess them for recurrent disease," he explained. "We wanted to look at the differences, look at the combined value, and compare the prognostic value of FDG-PET/CT [and] CA-125 monitoring."

Dr. Javadi and colleagues retrospectively looked at 30 patients who had been diagnosed with stage?III/IV ovarian cancer with CA-125-producing tumors. Patients had 157 PET/CT scans and serial CA-125 screenings. Patients were followed for either pathologic or clinical outcome based on all available clinical data, including subsequent imaging, according to Dr. Javadi.

Rigorous Evaluation

"If someone had a negative PET scan, then a positive [magnetic resonance imaging] in 3 months, and a positive PET scan right after that, it would have been a false-negative PET scan that was initially seen," said Dr. Javadi. "We wanted to be as rigorous as we could in evaluating PET/CT. Whether or not it was microscopic disease at the time, we still stated that it was a false-negative scan."

The mean follow-up time in the study was 5 years, noted Dr. Javadi.

The study found PET/CT sensitivity in identifying recurrence to be 90%, better than CA-125 analysis using the Bristow (58%) or the Gynecologic Cancer Intergroup (GCIG; 26%) criteria. For specificity, PET was 91%, Bristow 89%, and GCIG 100%. The positive predictive value of PET, Bristow, and GCIG techniques were 91%, 85%, and 100%, respectively. The negative predictive value of PET, Bristow, and GCIG were 90%, 67%, and 57%, respectively.

Investigators concluded that a negative PET scan subsequent to primary treatment or successful treatment of recurrence is associated with a mean disease-free survival of about 1.5 years.

"Having a negative PET after primary therapy was predictive of greater progression-free survival than?.?.?. a positive PET right after primary therapy," said Dr. Javadi. "We didn't see the same difference [in progression-free survival] with CA-125 analysis."

The next step is to conduct a prospective randomized study with a set protocol and set follow-up time, added Dr. Javadi.

"I do see an important role for PET technology in ovarian cancer," said Peter Conti, MD, PhD, past president of the Society of Nuclear Medicine and professor of radiology at the University of Southern California at Los Angeles.

"Blood markers and tests like CA-125 tell you that there is an abnormality, but they don't tell you where the abnormality is," Dr. Conti told Medscape Radiology. "Moreover, not all cancers are CA-125 positive. While it is useful for screening, it is useful for screening in a select population that has the expression [of CA-125] at baseline.

The study raises the merit of developing a collection of information that combines data from blood markers, imaging, and clinical examination, according to Dr. Conti. "The composite of all that information is more powerful [than using a single serum tumor marker]," said Dr. Conti.

The study was independently conducted. Dr. Javadi and Dr. Conti have disclosed no relevant financial relationships.

Society of Nuclear Medicine (SNM) 56th Annual Meeting: Abstract 174. Presented June 15, 2009.
J Nucl Med. 2009;50(Suppl 2):45P.

    
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