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胃癌是全球第五大常见的恶性肿瘤,其病死率位居第三[1]。诱发胃癌的高危因素包括幽门螺旋杆菌感染、年龄因素和饮食因素(高盐、少水果和蔬菜)[2]。早期胃癌的标准治疗是行内镜黏膜下剥离术。局部进展期胃癌可通过手术切除肿瘤以及行胃周围淋巴结和腹腔干分支周围淋巴结清扫术进行治疗,围手术期化疗能改善进展期可切除胃癌的患者的预后。晚期胃癌应用化疗,患者的中位生存期不足1年。应用于胃癌治疗的抗体类药物有以下几种:曲妥珠单抗针对人表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)阳性的肿瘤,为胃癌治疗的一线药物;雷姆西单抗通过抗肿瘤血管生成来抑制肿瘤进展,为胃癌治疗的二线药物;尼伐单抗是程序性死亡受体1的抑制剂,为胃癌治疗的三线药物。
胃癌治疗策略的选择与其分期和分子生物学特征直接相关。通过内窥镜活检可获得组织学诊断;通过内镜超声、增强CT、PET/CT和腹腔镜检查可进行癌症分期。18F-FDG PET/CT检查作为反映糖酵解代谢功能的影像手段,已在多种恶性肿瘤的诊断、分期、预后和复发检测中发挥重要作用,其在胃癌中的应用既有优势也存在局限性和有待解决的问题。
18F-FDG PET/CT在胃癌中的临床应用进展
Research progress in the clinical application of 18F-FDG PET/CT in gastric cancer
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摘要: 胃癌是全球范围内最常见的恶性肿瘤之一。18F-氟脱氧葡萄糖(FDG)PET/CT在胃癌中的应用既有优点又有局限性。胃癌原发灶对18F-FDG的摄取与癌症分期、组织学分型和肿瘤大小密切相关。早期胃癌18F-FDG摄取阳性预示着内镜黏膜下剥离术的不可治愈性。进展期胃癌的最大标准化摄取值(SUVmax)在肠型与印戒细胞癌(SRC)或弥漫型胃癌间的差异显著,SRC的SUVmax与患者的总生存时间和无病生存时间呈负相关。18F-FDG PET/CT对区域淋巴结转移的诊断灵敏度较低,但其特异度很高,区域淋巴结对18F-FDG摄取呈阳性是预后不良的指征。18F-FDG PET/CT可检出隐匿的远处转移(7.2%~10.0%),其中大部分(4.7%~8.8%)使用腹腔镜也不能检出。常规性应用18F-FDG PET/CT并联合腹腔镜检查对明确胃癌分期的意义重大。因此,笔者就18F-FDG PET/CT在胃癌中的临床应用进展进行综述。
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关键词:
- 胃肿瘤 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 氟脱氧葡萄糖F18 /
- 肿瘤分期 /
- 肿瘤转移 /
- 预后
Abstract: Gastric cancer is one of the commonest malignant tumors in the world. The application of 18F-fluorodeoxyglucose (FDG) PET/CT in gastric cancer has both advantages and limitations. 18F-FDG uptake in primary gastric cancer is closely related to cancer staging, histological classification and tumor size. Positive 18F-FDG uptake in early gastric cancer often indicates the incurability of endoscopic submucosal dissection. Maximum standardized uptake value (SUVmax) of advanced gastric cancer is significantly different between intestinal type and signet ring cell carcinoma (SRC) or diffuse type gastric cancer; SUVmax of SRC is negatively correlated with the overall survival time and disease-free survival time of patients. The sensitivity of 18F-FDG PET/CT for regional lymph node metastasis is low, but the specificity is high. Regional lymph nodes with positive 18F-FDG uptake indicate poor prognosis. 18F-FDG PET/CT can detect occult distant metastases (7.2%~10.0%), most of which (4.7%~8.8%) cannot be detected by laparoscopy. Routine application of 18F-FDG PET/CT combined with laparoscopy is of great significance in determining the staging of gastric cancer. -
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