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JAMA：肝切除术前行PET对结直肠腺癌转移外科治疗的影响

2014-05-31 张福奎 译 医学论坛网

结直肠肝切除术PET
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意义：结直肠癌肝转移的患者接受根治性肝切除术。正电子发射体层摄影联合计算机体层摄影(PET-CT)通过识别有隐匿转移病变的患者，可能有助于避免非根治性手术。目的：确定与未行PET-CT(对照)相比，术前PET-CT对有可切除性转移病变患者外科治疗的影响，研究PET-CT对生存率的影响，以及标准化摄取值(体重校正的组织放射性与注入放射性的比值)与生存率之间的相关性。设计、场所和参与者：在2005～2

意义：结直肠癌肝转移的患者接受根治性肝切除术。正电子发射体层摄影联合计算机体层摄影(PET-CT)通过识别有隐匿转移病变的患者，可能有助于避免非根治性手术。

目的：确定与未行PET-CT(对照)相比，术前PET-CT对有可切除性转移病变患者外科治疗的影响，研究PET-CT对生存率的影响，以及标准化摄取值(体重校正的组织放射性与注入放射性的比值)与生存率之间的相关性。

设计、场所和参与者：在2005～2013年期间，由加拿大安大略省9家医院的21位外科医师参与，应用5家学术机构的PET-CT扫描机，对如下患者进行一项随机试验：年龄>18岁接受外科手术治疗的结直肠癌患者，之前30天内胸部、腹部和骨盆CT扫描发现了可切除性转移灶，之前18个月内做过一次清晰的结肠镜检查。

干预措施：采用2:1的比例，将患者随机分至PET-CT组或对照组。

主要转归和检测指标：主要转归为外科治疗的改变，定义为取消肝脏手术、更广泛的肝脏手术或基于PET-CT结果施行了其他器官手术。次要转归为生存率。

结果：在接受PET-CT的263例患者中，21例的外科治疗发生改变[8.0%，95%可信区间(CI)为5.0%～11.9%)，具体来说，7例(2.7%)患者未接受开腹术，4例(1.5%)患者接受更广泛的肝脏手术，9例(3.4%)患者接受其他器官手术(其中8例接受了肝切除术)，有1例患者接受了开腹手术，但是未进行肝脏手术即关腹。PET-CT组中91%患者和对照组中92%患者，进行了肝切除术。在中位随访36个月后，PET-CT组的估计死亡率为11.13(95%CI为8.95～13.68)例次事件/1000人-月，对照组为12.71(95%CI为9.40～16.80)例次事件/1000人-月。两组之间的生存率无差异[风险比为0.86(95%CI为0.60～1.21)，P=0.38]。标准化摄取值和生存率相关[每增加1个单位的风险比为1.11(90%CI为1.07～1.15)，P<0.001]。纳入标准化摄取值模型的C统计值为0.62(95%CI为0.56～0.68)，未纳入标准化摄取值模型的C统计值为0.50(95%CI为0.44～0.56)。C统计值之差为0.12(95%CI为0.04～0.21)。低C统计值提示，标准化摄取值不是总生存率的强预测因子。

结论和相关性：在有潜在可切除性肝转移病变的结直肠腺癌患者中，与单用CT相比，PET-CT的应用并未引起外科治疗的频繁改变。这些结果对PET-CT扫描在上述情况下的价值提出疑问。

原始出处：

Moulton CA, Gu CS, Law CH, Tandan VR, Hart R, Quan D, Fairfull Smith RJ, Jalink DW, Husien M, Serrano PE, Hendler AL, Haider MA, Ruo L, Gulenchyn KY, Finch T, Julian JA, Levine MN, Gallinger S.Effect of PET before liver resection on surgical management for colorectal adenocarcinoma metastases: a randomized clinical trial. JAMA : the journal of the American Medical Association" style="font-family: arial, helvetica, clean, sans-serif; font-size: 0.923em; line-height: 17.999801635742188px;">JAMA. 2014 May 14;311(18):1863-9.

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    2015-02-12 doctorzheng

    #切除术#

    0

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    2014-10-25 changfy

    #肝切除#

    0

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    2014-08-30 feather89

    #PE#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1876673, encodeId=990918e667355, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu Feb 12 23:20:00 CST 2015, time=2015-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1926389, encodeId=5d6a192638924, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sat Oct 25 04:20:00 CST 2014, time=2014-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725614, encodeId=8d601e25614f0, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Aug 30 09:20:00 CST 2014, time=2014-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331027, encodeId=9617133102e6e, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417871, encodeId=9366141e871f6, content=<a href='/topic/show?id=bcb081181dc' target=_blank style='color:#2F92EE;'>#肝切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81181, encryptionId=bcb081181dc, topicName=肝切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bcb3304824, createdName=zexyw02, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1452690, encodeId=7573145269066, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590252, encodeId=107d1590252c9, content=<a href='/topic/show?id=2c17e154824' target=_blank style='color:#2F92EE;'>#癌转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71548, encryptionId=2c17e154824, topicName=癌转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dc017794099, createdName=linagood, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=)]
    2014-06-02 ms7514935887898259

    #PET#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1876673, encodeId=990918e667355, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu Feb 12 23:20:00 CST 2015, time=2015-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1926389, encodeId=5d6a192638924, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sat Oct 25 04:20:00 CST 2014, time=2014-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725614, encodeId=8d601e25614f0, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Aug 30 09:20:00 CST 2014, time=2014-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331027, encodeId=9617133102e6e, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417871, encodeId=9366141e871f6, content=<a href='/topic/show?id=bcb081181dc' target=_blank style='color:#2F92EE;'>#肝切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81181, encryptionId=bcb081181dc, topicName=肝切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bcb3304824, createdName=zexyw02, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1452690, encodeId=7573145269066, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590252, encodeId=107d1590252c9, content=<a href='/topic/show?id=2c17e154824' target=_blank style='color:#2F92EE;'>#癌转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71548, encryptionId=2c17e154824, topicName=癌转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dc017794099, createdName=linagood, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=)]
    2014-06-02 zexyw02

    #肝切除术#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1876673, encodeId=990918e667355, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu Feb 12 23:20:00 CST 2015, time=2015-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1926389, encodeId=5d6a192638924, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sat Oct 25 04:20:00 CST 2014, time=2014-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725614, encodeId=8d601e25614f0, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Aug 30 09:20:00 CST 2014, time=2014-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331027, encodeId=9617133102e6e, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417871, encodeId=9366141e871f6, content=<a href='/topic/show?id=bcb081181dc' target=_blank style='color:#2F92EE;'>#肝切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81181, encryptionId=bcb081181dc, topicName=肝切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bcb3304824, createdName=zexyw02, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1452690, encodeId=7573145269066, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590252, encodeId=107d1590252c9, content=<a href='/topic/show?id=2c17e154824' target=_blank style='color:#2F92EE;'>#癌转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71548, encryptionId=2c17e154824, topicName=癌转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dc017794099, createdName=linagood, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=)]
    2014-06-02 crystal0564

    #结直肠#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1876673, encodeId=990918e667355, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu Feb 12 23:20:00 CST 2015, time=2015-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1926389, encodeId=5d6a192638924, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sat Oct 25 04:20:00 CST 2014, time=2014-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725614, encodeId=8d601e25614f0, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Aug 30 09:20:00 CST 2014, time=2014-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331027, encodeId=9617133102e6e, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417871, encodeId=9366141e871f6, content=<a href='/topic/show?id=bcb081181dc' target=_blank style='color:#2F92EE;'>#肝切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81181, encryptionId=bcb081181dc, topicName=肝切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bcb3304824, createdName=zexyw02, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1452690, encodeId=7573145269066, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590252, encodeId=107d1590252c9, content=<a href='/topic/show?id=2c17e154824' target=_blank style='color:#2F92EE;'>#癌转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71548, encryptionId=2c17e154824, topicName=癌转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dc017794099, createdName=linagood, createdTime=Mon Jun 02 14:20:00 CST 2014, time=2014-06-02, status=1, ipAttribution=)]
    2014-06-02 linagood

    #癌转移#

    0