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中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (04) : 253 -257. doi: 10.3877/cma.j.issn.2095-7157.2023.04.004

论著

68Ga-NC-BCH联合PET-CT淋巴结免疫示踪对于胃癌患者术前及术后临床决策影响的初步探索研究
王佳凤, 郭锐, 陈倩倩, 李惠凯, 宁波, 袁新普, 朱华(), 令狐恩强()   
  1. 100853 北京,解放军医学院;100853 北京,解放军总医院第一医学中心消化内科
    100142 北京,北京大学肿瘤医院核医学科
    100853 北京,解放军总医院第一医学中心消化内科
    100853 北京,解放军总医院第一医学中心普通外科
  • 收稿日期:2023-10-05 出版日期:2023-11-15
  • 通信作者: 朱华, 令狐恩强
  • 基金资助:
    国家十四五重点研发计划(2022YFC2503600)

A preliminary exploratory study of the impact of 68Ga-NC-BCH combined with PET-CT lymph node immune tracer techniques on preoperative and postoperative clinical decision-making for gastric cancer patients

Jiafeng Wang, Rui Guo, Qianqian Chen, Huikai Li, Bo Ning, Xinpu Yuan, Hua Zhu(), Enqiang Linghu()   

  1. Medical School of Chinese PLA, Beijing 100853, China; Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
    Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
    Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
    Senior Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
  • Received:2023-10-05 Published:2023-11-15
  • Corresponding author: Hua Zhu, Enqiang Linghu
引用本文:

王佳凤, 郭锐, 陈倩倩, 李惠凯, 宁波, 袁新普, 朱华, 令狐恩强. 68Ga-NC-BCH联合PET-CT淋巴结免疫示踪对于胃癌患者术前及术后临床决策影响的初步探索研究[J]. 中华胃肠内镜电子杂志, 2023, 10(04): 253-257.

Jiafeng Wang, Rui Guo, Qianqian Chen, Huikai Li, Bo Ning, Xinpu Yuan, Hua Zhu, Enqiang Linghu. A preliminary exploratory study of the impact of 68Ga-NC-BCH combined with PET-CT lymph node immune tracer techniques on preoperative and postoperative clinical decision-making for gastric cancer patients[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(04): 253-257.

目的

腹腔镜/机器人根治性切除术及超级微创手术(SMIS)是目前胃癌治疗的主要手术方式。但是在术前及术后临床决策中存在以下问题:(1)腹腔镜/机器人根治性切除术前对于淋巴结清扫范围的准确判定仍缺乏有效手段;(2)超级微创手术非治愈性切除术后是否存在胃周淋巴结转移的准确判定仍存在困难。目前,胃癌抗原特异性造影剂68Ga-NC-BCH联合正电子发射计算机断层显像(PET/CT)对于指导胃癌患者嵌合抗原受体T细胞免疫疗法(CART)治疗显示出了良好效果,但是其可否联合淋巴结免疫示踪用于指导胃癌患者术前及术后临床决策尚无相关研究。因此,本研究旨在探索68Ga-NC-BCH联合PET-CT淋巴结免疫示踪对于胃癌患者术前及术后临床决策的影响。

方法

选取2023年4月至2023年9月于解放军总医院就诊的5例进展期胃癌患者,术前行腹部CT检查及68Ga-NC-BCH联合PET-CT淋巴结免疫示踪,随后进行腹腔镜/机器人胃癌切除术并进行扩大淋巴结清扫。

结果

5例患者中,3例(60%)术前CT提示胃周淋巴结肿大,但68Ga-NC-BCH联合PET-CT淋巴结免疫示踪未见异常,术后扩大淋巴结切除病理结果提示上述3例患者均未见癌组织。5例患者术前68Ga-NC-BCH联合PET-CT淋巴结免疫示踪结果与术后淋巴结病理检查结果均一致(100%),上述结果初步提示较CT相比,68Ga-NC-BCH联合PET-CT淋巴结免疫示踪对于胃癌患者胃周淋巴结转移的判定具有更高的准确性。

结论

本研究初步证实了68Ga-NC-BCH探针联合PET-CT淋巴结免疫示踪指导胃癌患者术前及术后临床决策的可行性及安全性,但上述结论还需要大样本的前瞻性研究进一步证实。

Objective

Laparoscopic/robotic radical resection and super minimally invasive surgery(SMIS)are currently the main surgical methods for the treatment of gastric cancer.However, there are the following issues in clinical decision-making before and after surgery: (1)There is still a lack of effective means for accurately determining the scope of lymph node dissection in laparoscopic/robotic radical resection surgery; (2)There are still difficulties in accurately determining the presence of lymph node metastasis around the stomach after non-curative resection of super minimally invasive surgery.Currently, the use of the antigen-specific imaging agent 68Ga-NC-BCH in combination with positron emission tomography-computed tomography (PET/CT) has shown promising results in guiding Chimeric Antigen Receptor T-Cell Immunotherapy (CART) treatment for gastric cancer patients. However, there is no relevant research on whether it can be combined with lymph node immune tracing to guide preoperative and postoperative clinical decisions for gastric cancer patients.Therefore, this study aims to explore the impact of 68Ga-NC-BCH combined with PET-CT lymph node immune tracing on preoperative and postoperative clinical decisions for gastric cancer patients.

Methods

From April to September 2023, five cases of advanced gastric cancer patients who received treatment at the First Medical Center of PLA General Hospital were selected. Prior to surgery, abdominal CT scans and 68Ga-NC-BCH combined PET-CT lymph node immune tracing were performed, followed by laparoscopic/robotic gastric cancer resection and extended lymph node dissection.

Result

Among the 5 cases, preoperative CT scans indicated enlarged gastric lymph nodes in 3 cases (60%). However, lymph node immunostaining using 68Ga-NC-BCH combined with PET-CT did not reveal any abnormalities. Postoperative pathological examination of the enlarged lymph nodes confirmed the absence of cancer tissue in all 3 cases.The results of preoperative lymph node immunostaining using 68Ga-NC-BCH combined with PET-CT were consistent with postoperative pathological examination results in all 5 cases (100%). These preliminary findings suggest that compared to CT, lymph node immunostaining using 68Ga-NC-BCH combined with PET-CT has higher accuracy in determining gastric lymph node metastasis in patients with gastric cancer.

Conclusion

This study preliminarily confirmed the feasibility and safety of using 68Ga-NC-BCH combined with PET-CT lymph node immune tracing to guide preoperative and postoperative clinical decisions for gastric cancer patients. However, further prospective studies with larger sample sizes are needed to confirm the above conclusion.

图1 患者入组流程图
表1 患者一般情况
表2 淋巴结检查PET/CT外科手术病理诊断结果
[25]
Fan LLi JZhang H,et al.Machine learning analysis for the noninvasive prediction of lymphovascular invasion in gastric cancer using PET/CT and enhanced CT-based radiomics and clinical variables[J]. Abdom Radiol (NY)202247(4):1209-1222.
[26]
Findlay JMAntonowicz SSegaran A,et al.Routinely staging gastric cancer with 18F-FDG PET-CT detects additional metastases and predicts early recurrence and death after surgery[J].Eur Radiol201929(5): 2490-2498.
[27]
Perlaza POrtín JPagès M,et al.Should 18F-FDG PET/CT Be Routinely Performed in the Clinical Staging of Locally Advanced Gastric Adenocarcinoma? [J].Clin Nucl Med201843(6):402-410.
[28]
Baek JHPark DJKim GY,et al.Clinical Implications of Claudin18.2 Expression in Patients With Gastric Cancer[J].Anticancer Res, 201939(12):6973-6979.
[29]
Cao WXing HLi Y,et al.Claudin18.2 is a novel molecular biomarker for tumor-targeted immunotherapy[J].Biomark Res2022, 10(1):38.
[30]
Rohde CYamaguchi RMukhina S,et al. Comparison of Claudin 18.2 expression in primary tumors and lymph node metastases in Japanese patients with gastric adenocarcinoma[J].Jpn J Clin Oncol201949(9): 870-876.
[1]
Wang SQi CDing J,et al.First-in-human CLDN18.2 functional diagnostic pet imaging of digestive system neoplasms enables whole-body target mapping and lesion detection[J]. Eur J Nucl Med Mol Imaging202350(9):2802-2817.
[2]
Sato YOkamoto KKawano Y,et al.Novel Biomarkers of Gastric Cancer: Current Research and Future Perspectives[J].J Clin Med202312(14):4646.
[3]
Jiang HShi ZWang P,et al.Claudin18.2-Specific Chimeric Antigen Receptor Engineered T Cells for the Treatment of Gastric Cancer[J].J Natl Cancer Inst2019111(4):409-418.
[4]
Qi CGong JLi J,et al.Claudin18.2-specific CAR T cells in gastrointestinal cancers:phase 1 trial interim results[J].Nat Med2022, 28(6):1189-1198.
[5]
Entezam MSanaei MJMirzaei Y,et al.Current progress and challenges of immunotherapy in gastric cancer:A focus on CAR-T cells therapeutic approach[J].Life Sci2023318:121459.
[6]
Zhao CRong ZDing J,et al.Targeting Claudin 18.2 Using a Highly Specific Antibody Enables Cancer Diagnosis and Guided Surgery[J].Mol Pharm202219(10):3530-3541.
[7]
Hu GZhu WLiu Y,et al.Development and comparison of three 89Zr-labeled anti-CLDN18.2 antibodies to noninvasively evaluate CLDN18.2 expression in gastric cancer:a preclinical study[J].Eur J Nucl Med Mol Imaging202249(8):2634-2644.
[8]
Smyth ECNilsson MGrabsch HI,et al. Gastric cancer[J].Lancet, 2020396(10251):635-648.
[9]
Machlowska JBaj JSitarz M,et al.Gastric Cancer: Epidemiology, Risk Factors, Classification, Genomic Characteristics and Treatment Strategies[J].Int J Mol Sci202021(11):4012.
[10]
Kinami SNakamura NTomita Y,et al.Precision surgical approach with lymph-node dissection in early gastric cancer[J].World J Gastroenterol201925(14):1640-1652.
[11]
Hiramatsu YTakeuchi HGoto O,et al.Minimally Invasive Function-Preserving Gastrectomy with Sentinel Node Biopsy for Early Gastric Cancer[J].Digestion.
[12]
Linghu E.A new stage of surgical treatment: super minimally invasive surgery[J].Chin Med J (Engl)2022135(1):1-3.
[13]
Liu QDing LQiu X,et al.Updated evaluation of endoscopic submucosal dissection versus surgery for early gastric cancer:A systematic review and meta-analysis[J].Int J Surg202073(1):28-41.
[14]
Song WCQiao XLGao XZ.A comparison of endoscopic submucosal dissection (ESD) and radical surgery for early gastric cancer: a retrospective study[J].World J Surg Oncol201513(1):309.
[15]
Quero GFiorillo CLongo F,et al.Propensity score-matched comparison of short- and long-term outcomes between surgery and endoscopic submucosal dissection (ESD) for intestinal type early gastric cancer (EGC) of the middle and lower third of the stomach: a European tertiary referral center experience[J].Surg Endosc202135(6):2592-2600.
[16]
Park KBJeon CHSeo HS,et al.Operative safety of curative gastrectomy after endoscopic submucosal dissection (ESD) for early gastric cancer - 1:2 propensity score matching analysis: A retrospective single-center study (cohort study) [J].Int J Surg202080(1):124-128.
[17]
Fujishiro MYoshida SMatsuda R, et al.Updated evidence on endoscopic resection of early gastric cancer from Japan[J].Gastric Cancer, 201720(Suppl 1):39-44.
[18]
Lee GHLee EPark B,et al.Long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated intramucosal gastric cancer regardless of size[J].World J Gastroenterol202228(8): 840 -852.
[19]
Chu YNYu YNJing X,et al.Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer[J].World J Gastroenterol201925(35):5344-5355.
[20]
Akiyama YKatai HKitabayashi R,et al.Frequency of lymph node metastasis according to tumor location in clinical T1 early gastric cancer: supplementary analysis of the Japan Clinical Oncology Group study (JCOG0912) [J]. J Gastroenterol202358(6):519-526.
[21]
Hanada YChoi AYHwang JH,et al.Low Frequency of Lymph Node Metastases in Patients in the United States With Early-stage Gastric Cancers That Fulfill Japanese Endoscopic Resection Criteria[J].Clin Gastroenterol Hepatol201917(9):1763-1769.
[22]
Duan KLi DShi D,et al.Risk Factors and Timing of Additional Surgery after Noncurative ESD for Early Gastric Cancer[J].Can J Gastroenterol Hepatol20222022:3421078.
[23]
Hatta WGotoda TKoike T,et al.History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer[J]. Dig Endosc202032(2):180-190.
[24]
Sekiguchi MSuzuki HOda I,et al.Risk of recurrent gastric cancer after endoscopic resection with a positive lateral margin[J].Endoscopy, 201446(4):273-278.
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