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Abstract：
Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, a retrospective study was performed including 134 CRC patients referred for PET/CT imaging on the suspicion of recurrence, based on elevated CEA and/or CA 19-9 and/or equivocal CIM findings. According to our institution\'s Tumor Board CRC protocol, after the initial treatment, which was dependent on the TNM stage (neoadjuvant therapy, primary resection, or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy, every six months. The statistics, including univariate and multivariate analyses were conducted using the IBM SPSS 20.0 statistical software. p-values < 0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. PET/CT showed high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA showed a high sensitivity of 98.1% but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy for CA 19-9 and CIM for diagnosis of CRC recurrence were 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824-0.946; p < 0.001), 0.844 (95% CI: 0.772-0.916; p < 0.001), 0.753 (95% CI: 0.612-0.844; p < 0.001), and 0.547 (95% CI: 0.442-0.652; p = 0.358), respectively. Univariate analysis showed that both PET/CT and CIM positive results were highly associated with CRC recurrence (p < 0.001 and p < 0.001, respectively). At the same time, gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) had no significance (p = 0.211, p = 0.158, p = 0.583, and p = 0.201, respectively). Our multivariate analysis showed that independent predictors for CRC recurrence are positive PET/CT scans (p < 0.001), positive CIM results (p = 0.001), and elevated CA 19-9 levels (p = 0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p = 0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting the CRC recurrence (p = 0.023). Conclusions: F-18 FDG PET/CT showed high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the post-operative follow-op in patients with elevated tumor markers.
摘要：
背景/目标：尽管PET/CT成像在肿瘤学中的作用已得到确认，其在复发性结直肠癌（CRC）常规监测中的诊断价值仍存在争议。目的评价F-18FDGPET/CT与CEA相关对CRC复发的诊断价值。CA19-9级，和常规成像模式（CIM）。方法：在2009年至2023年之间，进行了一项回顾性研究，包括134例因怀疑复发而进行PET/CT成像的CRC患者。基于升高的CEA和/或CA19-9和/或模棱两可的CIM发现。根据我们机构的肿瘤委员会CRC协议，在最初的治疗之后,这取决于TNM阶段(新辅助治疗，原发性切除,或辅助治疗)，患者接受标准的5年监测，包括CEA和CA19-9测量，CIM,和结肠镜检查，每六个月。统计数据，采用IBMSPSS20.0统计软件进行单变量和多变量分析.P值<0.05被认为是统计学上显著的。结果：在54/134（40.3%）肿瘤标志物升高的患者中证实了复发的CRC。PET/CT在检测复发性CRC方面具有较高的诊断效能，特异性，PPV,NPV,准确率为94.4%，82.5%,78.5%,95.7%,和87.3%，分别。CEA显示了98.1%的高灵敏度，但低特异性和准确度分别为15%和48.5%，分别。敏感性,特异性，CA19-9和CIM诊断CRC复发的准确率为44.4%，67.5%,58.2%,51.9%，98.8%,79.9%,分别。PET/CT的AUC,CEA水平升高,CIM,CA19-9水平升高为0.885(95%CI:0.824-0.946;p<0.001)，0.844（95%CI：0.772-0.916；p<0.001），0.753（95%CI：0.612-0.844；p<0.001），和0.547（95%CI：0.442-0.652；p=0.358），分别。单因素分析显示，PET/CT和CIM阳性结果均与CRC复发高度相关（分别为p<0.001和p<0.001）。同时,性别,粘液性肿瘤类型，存在初始淋巴结转移（N+），和初始远处转移（M）的存在没有意义（分别为p=0.211，p=0.158，p=0.583和p=0.201）。我们的多变量分析表明，CRC复发的独立预测因素是PET/CT扫描阳性（p<0.001），CIM阳性结果（p=0.001），和升高的CA19-9水平（p=0.023）。尽管在单变量分析中未检测到CA19-9作为统计学上有意义的预测因子（p=0.358），在多变量分析中,它被认为是检测CRC复发的重要预测因子(p=0.023).结论:F-18FDGPET/CT在CRC复发检测中具有较高的诊断效能,与CEA水平相关，CA19-9级，和CIM.对于肿瘤标志物升高的患者，应将这种成像方式常规纳入术后随访中。
