Heterogeneidad del tumor primario en la18F-FDG PET/TC pretratamiento para predecir el pronóstico en pacientes con cáncer de recto sometidos a cirugía tras terapia neoadyuvante / Primary tumor heterogeneity on pretreatment18F-FDG PET/CT to predict outcome in patients with rectal cancer who underwent surgery after neoadjuvant therapy

Objetivo Estudio retrospectivo cuyo objetivo fue investigar el valor de las características de textura de los tumores primarios en la PET/TC con 18F-FDG pretratamiento para la predicción de la respuesta al tratamiento, la progresión y la supervivencia global en pacientes con cáncer de recto que se sometieron a cirugía después de la terapia neoadyuvante (TNA). Métodos Se incluyeron en este estudio pacientes con cáncer de recto que se sometieron a estudio PET/TC con 18F-FDG antes del tratamiento y se sometieron a cirugía después de TNA. Se registraron las características clínico-patológicas, la fecha del último seguimiento, la evolución y fallecimiento. Los parámetros de las texturas y los convencionales de PET (Standard Uptake Value-SUVmax, volumen tumoral metabólico-MTV, glucólisis total de la lesión-TLG) se obtuvieron a partir de imágenes PET/TC utilizando el programa LifeX. Los parámetros se agruparon utilizando el índice de Youden en el análisis ROC. Los factores que predicen la respuesta patológica al tratamiento, la progresión y la supervivencia global se determinaron mediante regresión logística y análisis de regresión de Cox. Resultados Cuarenta y cuatro pacientes (26-59% hombres, 18-41% mujeres; 60,1 ± 11,4 años) con cáncer de recto fueron incluidos en este estudio. El número de pacientes respondedores y no respondedores a TNA fueron de 15 (34,9%) y 28 (65,1%), respectivamente. La mediana de la duración del seguimiento fue de 29,9 meses. 9 (20,5%) mostraron progresión de la enfermedad y 8 (18,2%) fallecieron durante el período de seguimiento. Los parámetros de entropía GLCM de diferencia y correlación GLCM se encontraron como predictores independientes para la respuesta a TNA. Los parámetros de positividad del margen quirúrgico, rango intercuartílico de intensidad CONV y textura AUC-CSHDISC fueron predictores independientes de progresión (AU)

Purpose This retrospective study aimed to investigate the value of texture features of primary tumors in pretreatment18F-FDG PET/CT in the prediction of response to treatment, progression, and overall survival in patients with rectal cancer who underwent surgery after neoadjuvant therapy (NAT). Method Patients with rectal cancer who had pretreatment18F-FDG PET/CT, and underwent surgery after NAT were included in this study. Clinicopathologic features, date of last follow-up, progression, and death were recorded. Textural and conventional PET parameters (maximum standardized uptake value-SUVmax, metabolic tumor volume-MTV, total lesion glycolysis-TLG) were obtained from PET/CT images using LifeX program. Parameters were grouped using Youden index in ROC analysis. Factors predicting the pathological response to treatment, progression, and overall survival were determined using logistic regression and Cox regression analyses. Results Forty-four patients (26(59%) male, 18 (41%) female; 60.1 ± 11.4 years) with rectal cancer were included in this study. The numbers of patients with responders and non-responders to NAT were15(34.9%) and 28(65.1%), respectively. One patient’ pathology report did not contain the response status to NAT. The median of follow-up duration was 29.9 months. 9(20.5%) showed disease progression, and 8(18.2%) died during the follow-up period. Difference entropy GLCM and correlation GLCM parameters were found as independent predictors for response to NAT. The positivity of surgical margin, intensity interquartile range CONV and AUC-CSHDISC texture parameters were independent predictors of progression, while normalized inverse difference GLCM and LZLGEGLZLM parameters were independent predictorsof mortality. Conclusion The texture parameters obtained from pretreatment18F-FDG PET/CT have presented a more robust predictive value than conventional parameters in patients with rectal cancer who underwent surgery after NAT (AU)

Evaluation of prognostic significance in extracapsular spread of pelvic lymph node metastasis in patients with cervical cancer.

BACKGROUND: Extracapsular spread of lymph node (LN) metastasis has been shown as a negative prognostic factor in cancers of several organs. This study was performed to clarify the prognostic significance of extracapsular spread of pelvic lymph node metastases in patients who underwent radical hysterectomy and pelvic, paraaortic lymphadenectomy for International Federation of Gynecology and Obstetrics (FIGO) Stage I-II cervical carcinoma. METHODS: Ninety-five patients were treated wih radical hysterectomy and pelvic paraaortic lymphadenectomy for Stage I-II cervical carcinoma. Twenty-one cases with positive nodes of the tumor and lymph nodes were reviewed. The describtion of the pattern of metastasis present in the node was focused on: maximal diameter of metastasis was compared with the maximal diameter of the node, the capsular integrity, and the type of immune response. The prognostic significance of extracapsular spread (ECS), maximal diameter of metastasis and the type of immune response of pelvic metastases was evaluated with respect to disease-free survival (DFS), overall survival, and the pattern of disease recurrence. RESULTS: ECS was seen in 52.4% (11/21) of the cases. The 5-year DFS rate in patients with ECS was significantly lower compared to patients without ECS (63.4% vs 100%; p = 0.03). To assess the independent impact of ECS on overall survival, the multivariate Cox regression model was not significantly different. CONCLUSION: From data in our study and those obtained from the literature, the occurence of ECS should be given in the pathology report. Including ECS in the classification of nodal involvement might be helpful in better prognostic discrimination of patients with metastatic lymph nodes.