^(18)F-FDG PET/CT代谢参数评估原发性皮肤恶性黑色素瘤晚期患者的预后  

Prognostic value of metabolic parameters measured by ^(18)F-FDG PET/CT in patients with primary advanced cutaneous malignant melanoma

作　　者：来瑞鹤 滕月 孙一文[1] 赵莲君 许守林[1] 蒋冲 Lai Ruihe;Teng Yue;Sun Yiwen;Zhao Lianjun;Xu Shoulin;Jiang Chong(Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 21008,China;The Comprehensive Cancer Centre,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院核医学科,南京210008 [2]南京大学医学院附属鼓楼医院肿瘤中心,南京210008

出　　处：《中华核医学与分子影像杂志》2023年第4期221-225,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的:探讨^(18)F-FDG PET/CT代谢参数在原发性皮肤恶性黑色素瘤(CMM)晚期患者中的预后价值。方法:回顾性分析2014年6月至2019年12月于南京大学医学院附属鼓楼医院经病理学初次确诊为CMM晚期的42例患者(男15例、女27例;中位年龄60.0岁)资料。所有患者行18F-FDG PET/CT检查,获取转移灶代谢参数:SUV_(max)、SUV_(mean)、总肿瘤代谢体积(TMTV)、病灶糖酵解总量(TLG)。采用ROC曲线分析得出PET代谢参数预测无进展生存(PFS)和总生存(OS)的最佳界值;将患者分为≥界值和<界值组,采用Kaplan-Meier法及log-rank检验分析2组间OS和PFS差异;采用单因素分析法及Cox比例风险模型筛选出PFS和OS的独立预后危险因素。结果:42例CMM晚期患者的中位随访时间为26.3个月,随访期间32例疾病进展,21例死亡;中位OS为33.1个月。转移灶SUV_(max)、SUV_(mean)、TMTV、TLG预测PFS/OS的最佳界值分别为4.63/4.77、3.31/3.31、8.22 cm^(3)/22.32 cm^(3)和18.22 g/51.37 g。Kaplan-Meier生存曲线及log-rank检验表明,SUV_(max)≥4.63、SUV_(mean)≥3.31的患者PFS更差(χ^(2)值:7.12、5.42,P值:0.008、0.020);SUV_(max)≥4.77、TMTV≥22.32 cm^(3)、TLG≥51.37 g的患者OS更差(χ^(2)值:4.73、5.60、6.31,P值:0.030、0.018、0.012)。多因素分析示,SUV_(max)为患者PFS[风险比(HR)=3.03(95%CI:1.23~7.45),P=0.016]及OS[HR=3.62(95%CI:1.19~11.00),P=0.023]的独立预后危险因素;TMTV和TLG为患者OS的独立预后危险因素[HR:2.87(95%CI:1.20~6.87)、3.34(95%CI:1.39~8.05),P值:0.018、0.007]。结论:基线18F-FDG PET/CT代谢参数在预测CMM晚期患者预后中有一定价值;转移灶SUV_(max)是CMM晚期患者PFS及OS的独立预后危险因素,而TMTV和TLG是OS的独立预后危险因素。Objective To investigate the prognostic value of metabolic parameters measured by ^(18)F-FDG PET/CT in patients with primary advanced cutaneous malignant melanoma(CMM).Methods A retrospective analysis was comprised of 42 patients with advanced CMM(15 males and 27 females;median age:60.0 years)from Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between June 2014 and December 2019.All patients were initially diagnosed by pathology,and underwent 18F-FDG PET/CT imaging.18F-FDG PET/CT parameters including SUV_(max),SUVmean,total metabolic tumor volume(TMTV)and total lesion glycolysis(TLG)of metastatic lesions were measured.ROC curve analysis was performed to obtain the optimal cut-off values of those metabolic parameters for predicting progression-free survival(PFS)and over-all survival(OS).Patients were divided into different groups based on their metabolic parameters(≥cut-off values or<cut-off values),and Kaplan-Meier survival curve and log-rank test were used to analyze the OS/PFS differences between 2 groups.The independent prognostic risk factors of PFS and OS were screened by univariate analysis and Cox proportional risk model.Results The median follow-up time of 42 patients with advanced CMM was 26.3 months,with 32 patients suffered from disease progression and 21 patients died,and the median survival was 33.1 months.The optimal cut-off values for PFS/OS were 4.63/4.77 for SUV_(max),3.31/3.31 for SUVmean,8.22 cm^(3)/22.32 cm^(3) for TMTV,and 18.22 g/51.37 g for TLG,respectively.Kaplan-Meier analysis and log-rank test showed that patients with SUV_(max)≥4.63 or SUVmean≥3.31 suffered from poorer PFS(χ^(2) values:7.12,5.42,P values:0.008,0.020),meanwhile,patients with SUV_(max)≥4.77 or TMTV≥22.32 cm^(3) or TLG≥51.37 g suffered from poorer OS(χ^(2) value:4.73,5.60,6.31,P values:0.030,0.018,0.012).Multivariate analysis demonstrated that SUV_(max) was significant predictor for both PFS(hazard risk(HR)=3.03(95%CI:1.23-7.45),P=0.016)and OS(HR=3.62(95%CI:1.19-11.00

关 键 词：黑色素瘤 皮肤 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 预后 

分 类 号：R739.5[医药卫生—肿瘤] R730.44[医药卫生—临床医学]