We analyzed whether preoperative18F-FDG PET/CT adds to conventional primary staging in patients with presumed non-metastatic colonic cancer (CC). The prognostic role of18F-FDG uptake in the primary tumor was evaluated after a mean follow-up of 15 years. Patients with a new diagnosis of presumed localized CC were prospectively enrolled and underwent presurgical18F-FDG PET/CT. For each colon lesion, SUVmax, SUVpeak, TLG, and MTV were assessed and tested as prognostic factors. Forty-eight patients were included. Post-surgery pathology identified a total of 103 colon lesions, including 58 invasive adenocarcinomas, 4 in situ adenocarcinomas, 3 adenomas with high-grade dysplasia, and 38 adenomas with low-grade dysplasia. Per lesion sensitivity, specificity, positive (PPVs) and negative predictive values (NPVs) for colonic primary tumor detection were 78%, 97%, 98%, and 73% for conventional workup, and 94%, 87%, 92%, and 89% for18F-FDG PET/CT. Only sensitivity was significantly different between18F-FDG PET/CT and conventional workup. PET detected an additional ten pathological colonic lesions in seven patients. SUVmax, SUVpeak, and TLG showed significant differences between invasive adenocarcinomas, in situ adenocarcinomas, and high-grade dysplasia compared to low-grade dysplasia. There was a statistically significant difference between pT1-pT2 and pT3-pT4 adenocarcinomas. On patient-based analysis, sensitivity, specificity, PPV, and NPV for nodal staging were 22%, 84%, 44%, and 65% for CECT, and 33%, 90%, 67%, and 70% for18F-FDG PET/CT, without a statistically significant difference. PET/CT also identified unknown metastatic spread and one synchronous lung cancer in four patients. Overall,18F-FDG PETCT had an additional diagnostic value in 11 out of 48 patients (23%).18F-FDG uptake of the primary tumor did not predict nodal or distant metastases. The difference in disease-free survival categorized by median SUVmax, SUVpeak, TLG, and MTV was not significant. Finally, preoperative18F-FDG PET/CT is valuable in detecting potential colon lesions not visualized by conventional workups, especially in cases of incomplete colonoscopy. It effectively highlights distant metastases but exhibits limitations for N staging. Mainly due to the relatively small sample size, the quantitative analysis of18F-FDG uptake in the primary tumor did not reveal any association with recurrence or disease-free survival, adding no significant prognostic information.
我们分析了术前18F-FDG PET/CT是否能为推测为非转移性结肠癌（CC）患者的常规初始分期提供额外信息。通过平均15年的随访，评估了原发肿瘤18F-FDG摄取的预后价值。前瞻性纳入新诊断为推测局限性结肠癌的患者，术前均接受18F-FDG PET/CT检查。针对每个结肠病灶，评估SUVmax、SUVpeak、TLG和MTV作为预后因素。共纳入48例患者。术后病理共检出103个结肠病灶，包括58个浸润性腺癌、4个原位腺癌、3个高级别异型增生腺瘤及38个低级别异型增生腺瘤。在病灶层面，常规检查对结肠原发肿瘤检测的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为78%、97%、98%和73%，而18F-FDG PET/CT分别为94%、87%、92%和89%。仅敏感性在18F-FDG PET/CT与常规检查间存在显著差异。PET在7例患者中额外检出10个病理性结肠病灶。SUVmax、SUVpeak和TLG在浸润性腺癌、原位腺癌及高级别异型增生与低级别异型增生间均呈现显著差异。pT1-pT2与pT3-pT4腺癌间存在统计学显著差异。在患者层面分析中，CECT对淋巴结分期的敏感性、特异性、PPV和NPV分别为22%、84%、44%和65%，而18F-FDG PET/CT分别为33%、90%、67%和70%，无统计学显著差异。PET/CT还在4例患者中发现未知转移灶及1例同时性肺癌。总体而言，18F-FDG PET/CT对48例患者中的11例（23%）具有额外诊断价值。原发肿瘤的18F-FDG摄取不能预测淋巴结或远处转移。按SUVmax、SUVpeak、TLG和MTV中位数分组的无病生存期差异不显著。综上，术前18F-FDG PET/CT在检测常规检查未发现的潜在结肠病灶方面具有重要价值，尤其在结肠镜检查不完整的情况下。其能有效发现远处转移，但在N分期方面存在局限。主要由于样本量相对较小，原发肿瘤18F-FDG摄取的定量分析未显示与复发或无病生存期的关联，未能提供显著的预后信息。
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