^(18F)-FDG PET/CT在胃癌中的临床应用进展

Research progress in the clinical application of ^(18)F-FDG PET/CT in gastric cancer

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。

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.