TITLE: The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: Results of the American College of Surgeons Oncology Group Z0060 trial
J Thorac Cardiovasc Surg 2007;133:738-745.
题目：正电子发射断层扫描术（PET）在具有手术可能性胸段食管癌分期中的应用：美国外科肿瘤学会Z0060号临床试验结果
J Thorac Cardiovasc Surg 2007;133:738-745.
胸心血管外科杂志 2007；133：738-745
Objectives: The American College of Surgeons Oncology Group trial Z0060 is a prospective multi-institutional trial with a primary objective to evaluate whether positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) detects evidence of metastastic disease that precludes esophagectomy in patients with esophageal cancer who are surgical candidates after routine staging.
目的：美国外科肿瘤学会Z0060号试验是一项多机构前瞻性研究，其目的在于评价对于常规分期后准备行食管切除手术的食管癌病人，应用F-18FDG-PET检测是否可发现远处转移。
Methods: Patients with resectable, biopsy-proven carcinoma were enrolled after computed tomography of chest and abdomen demonstrated no evidence of metastasis. FDG-PET was performed according to specified standards. FDG-PET findings suggesting metastases required confirmation and patients without metastases on PET were expected to proceed to surgery.
方法：病人均经活检证实，可手术切除并经过胸腹部CT扫描证实无远处转移。FDG-PET依照特定的标准施行，其结果提示有远处转移者需要进一步确认，对于PET显示无转移者可行手术。
Results: A total of 262 patients were registered. Of these, 199 were deemed eligible and of these, 189 patients were evaluable. Seventy-three patients were ineligible or unevaluable. Reasons for ineligibility included nonresectable disease by routine staging (39), missing or outdated staging procedures (12), PET technical protocol violations (10), no cancer (4), pre-PET induction therapy (3), claustrophobia (1), and other causes (4). There were 145 (78%) patients who went on to have surgery, 42 (22%) who did not, and 2 patients for whom the surgical status was not determined.
结果：共262例病人注册，其中199例被认为有资格，189例可评价，73例不合格或不可评价。不合格原因包括常规分期不适合手术者39例，失访或超出试验时间的分期过程者12例，PET技术诊断记录违背者10例，非癌者4例，行PET前诱导治疗，幽居恐怖症者1例，其他原因4例。其中145例（78%）行手术，42例（22%）未行手术，2例行手术病人状态不明。
The reasons for no resection included the following: M1 disease found by PET and confirmed (9), M1 disease found by PET and not confirmed (2), M1 disease at exploration not found by PET (7), decline or death before surgery (10), patient refusal of surgery (7), unresectable local tumor at exploration (5), and extensive N1 disease precluding operation (2). Eight (4.2%) patients undergoing resection had a recurrence in the first 6 months.
未切除原因如下：PET发现M1并经证实9例，PET发现但没有证实者2例，手术探查为M1者而PET未发现7例，手术前衰弱或死亡10例，拒绝手术者7例，经手术探查不能手术的局部肿瘤5例，术前广泛N1转移病人2例。8例病人（4.2%）术后6个月内复发。
Conclusions: Although 22% of eligible patients did not undergo esophagectomy, FDG-PET after standard clinical staging for esophageal carcinoma identified confirmed M1b disease in at least 4.8% (95% confidence interval: 2.2%-8.9%) of patients before resection. Unconfirmed PET evidence of M1 disease and regional adenopathy (N1 disease) led to definitive nonsurgical or induction therapy in additional patients.
结论：尽管22%的适宜病人未行食管切除手术，经标准临床试验分期后FDG-PET术前证实至少有4.8%的病人为M1（95%可信区间：2.2%-8.9%）。PET显示为M1或区域腺病（N1）者未经证实的患者行非手术或诱导治疗。题目：正电子发射断层扫描术（PET）在具有手术可能性胸段食管癌分期中的应用：美国外科肿瘤学会Z0060号临床试验结果