Prognostički parametri u rekurentnom kolorektalnom karcinomu: uloga kontrole ili ponovnog određivanja stepena bolesti FDG-PET/CT-om

  • Oguz Hancerliogullari University of Health Sciences, Gulhane Training and Research Hospital, Department of General Surgery, Ankara, Turkey
  • Kursat Okuyucu University of Health Sciences, Gulhane Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey
  • Semra Ince University of Health Sciences, Gulhane Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey
  • Subutay Peker University of Health Sciences, Gulhane Training and Research Hospital, Department of General Surgery, Ankara, Turkey
  • Nuri Arslan University of Health Sciences, Gulhane Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey
DOI: https://doi.org/10.2298/VSP170817065H
Ključne reči: kolorektalne neoplazme, neoplazme, određivanje stadijuma, prognoza, radiofarmaci, recidiv, osetljivost i specifičnost, tomografija, kompjuterizovana, emisiona, tomografija, kompjuterizovana, rendgenska

Sažetak


Uvod/Cilj. Kolorektalni karcinom se svrstava u treći najčešći karcinom na svetu. Kod približno 40% obolelih bolest se vraća posle hirurške resekcije. Određivanje prediktivnih parametara za relaps može pomoći u stratifikaciji i doprineti vođenju bolesnika. Još uvek je nedovoljan broj studija koje istražuju prediktivne faktore za relaps kolorektalnog karcinoma. Cilj rada bio je da se ispitaju prethodno definisani faktori rizika od razvoja metastaza i proceni klinički značaj preuzimanja 18F-fluoro­deoksi­glukoze (FDG). Metode. Studijom je bilo obuhvaćeno 56 bolesnika kojima je bilo potrebno uraditi FDG-PET/CT (FDG-pozitron emisionu tomografiju/kompjute-rizovanu tomografiju), zbog sumnje na relaps ili metastaze postevljene rutinskim testovima. Od 33 bolesnika kojima su finalnom patohisto­loškom dijagnozom utvrđeni relaps ili metastaze formirana je grupa sa malignitetima, dok je druga grupa ispitanika bila sa benignim promenama. Između te dve grupe ispitanika poređeni su sledeći faktori rizika: životno doba, serumski nivoi karcinoembrionskog antigena (CEA) i karbohidratni antigen 19-9 (CA 19-9), vrednost maksimalnog standardizovanog preuzimanja (SUVmax), veličina tumora, nalaz CT/magnetna rezonanca (MR), pol, primarna lokalizacija tumora, limfovaskularna invazija, perineuralna invazija (PNI), inicijalna neoadjuvantna terapija, inicijalna ekscizija metastatskih limfnih čvorova (ILNM), stadijum i diferencijacija tumora. Rezultati. Univarijantnom analizom utvrđena je statistička značajnost za CEA, Ca 19-9, SUVmax, veličinu tumora, PNI, ILNM, obrazac preuzimanja FDG, obrazac lezije na CT-u i diferencijacija tumora. Multivarijantnom analizom su SUVmax i ILNM utvrđeni kao glavni parametri rizika koji utiču na metastaze ili relaps. Srednji SUVmax iznosio je 7,25 u grupi bolesnika sa benignim promenama, a 11,7 u grupi sa malignitetima (p = 0,019). U grupi sa malignitetima ILNM je bio prisutan kod 66,5% ispitanika, a u grupi sa benignim promenama kod 30,5% ispitanika (p = 0,015). Za procenjeni cut-off od 6,3 i 12,5 na Receiver Operating Characteristic (ROC) liniji, izračunata specifičnost iznosila je 61% i 87%, redom. Zaključak. Glavni faktori rizika od relapsa kolorektalnog carcinoma su ILNM i SUVmax, zbog čega bolesnici sa tim faktorima rizika moraju biti pažljivo praćeni. Za otkrivanje relapsa ili metastaza kolorektalnog karcinoma FDG-PET/CT je veoma senzitivan test, a SUVmax poboljšava njegovu specifičnost.

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Objavljeno
2021/08/19
Broj časopisa
Vol. 77 Br. 2 (2020): Vojnosanitetski pregled
Rubrika
Originalni članak