摘要
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。
Abstract
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.
基金项目
国家十四五重点研发计划(2022YFC2503600)
万方数据