基线 18F-FDG PET/CT肿瘤内代谢异质性参数在原发性皮肤恶性黑色素瘤中的预后价值  

Prognostic value of intratumoral metabolic heterogeneity parameters of baseline 18F-FDG PET/CT in primary cutaneous malignant melanoma

作　　者：谭千倩 赵莲君 何健[1] 来瑞鹤 Tan Qianqian;Zhao Lianjun;He Jian;Lai Ruihe(Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 21008,China;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》2025年第3期154-158,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：南京鼓楼医院2024年临床研究专项资金(2024-LCYJ-PY-13)。

摘　　要：目的评估基线18F-FDG PET/CT肿瘤内代谢异质性参数在原发性皮肤恶性黑色素瘤(CMM)预后中的临床价值。方法回顾性分析2015年10月至2023年7月于南京大学医学院附属鼓楼医院35例确诊为原发性CMM并行基线18F-FDG PET/CT检查的患者[男24例、女11例,年龄(66.6±13.1)岁]的临床资料、18F-FDG PET/CT传统代谢参数[SUV_(max)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)]及PET肿瘤内代谢异质性参数[累积SUV体积直方图AUC(AUC-CSH)、线性回归斜率、SUV_(max)/SUV_(mean)],以30%、40%、50%、60%、70%、80%SUV_(max)或40%、60%、80%SUV_(max)为阈值勾画的MTV行一般线性回归,其斜率分别为异质性参数-1(HI-1)、异质性参数-2(HI-2);采用SUV阈值分别为2.5,40%、50%、60%、70%SUV_(max),计算出AUC-CSH、SUV_(max)/SUV_(mean)。采用Kaplan-Meier生存曲线和Cox比例风险模型分析原发灶PET代谢参数对疾病总生存(OS)和无进展生存(PFS)的预后价值。结果35例患者的中位随访时间为20.0个月,25例(71%)患者病情进展,16例(46%)患者死亡。多因素分析显示,HI-1、HI-2、MTV、SUV_(max)/SUV_(mean)2.5及SUV_(max)是PFS的独立预后危险因素[风险比(HR)(95%CI):0.32(0.13~0.82)、0.32(0.13~0.82)、3.86(1.34~11.12)、4.61(1.33~16.02)、4.06(1.55~10.61),均P<0.05],SUV_(max)及SUV_(max)/SUV_(mean)2.5是OS的独立预后危险因素[HR(95%CI):8.04(1.96~32.87)、2.87(1.09~7.51),P值:0.004、0.032]。结论HI-1、HI-2、SUV_(max)/SUV_(mean)2.5对CMM有预后价值,但AUC-CSH异质性参数预后价值不大。ObjectiveTo evaluate the clinical prognostic value of intratumoral metabolic heterogeneity parameters of baseline 18F-FDG PET/CT in primary cutaneous malignant melanoma(CMM).MethodsFrom October 2015 to July 2023,the clinical data of 35 patients(24 males,11 females,age(66.6±13.1)years)diagnosed with primary CMM who underwent baseline 18F-FDG PET/CT in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were retrospectively analyzed.Conventional metabolic parameters(SUV_(max),metabolic tumor volume(MTV),total lesion glycolysis(TLG))and PET intratumoral metabolic heterogeneity parameters(area under the cumulative SUV histograms curve(AUC-CSH),linear regression slope,SUV_(max)/SUV_(mean))were assessed.Using thresholds of 30%,40%,50%,60%,70%,and 80%SUV_(max) or thresholds of 40%,60%,and 80%SUV_(max) to delineate MTV,linear regression was performed,with the slopes being heterogeneity index-1(HI-1)and heterogeneity index-2(HI-2),respectively.Using SUV thresholds of 2.5,and 40%,50%,60%,and 70%SUV_(max) to calculate AUC-CSH and SUV_(max)/SUV_(mean).Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze the prognostic value of primary lesion PET metabolic parameters on overall survival(OS)and progression-free survival(PFS).ResultsThe median follow-up time of 35 patients was 20 months,with 25 patients(71%)experiencing disease progression and 16 patients(46%)deceased.Multivariate Cox regression analysis revealed that HI-1,HI-2,MTV,SUV_(max)/SUV_(mean)2.5,and SUV_(max) were the independent prognostic factors for PFS(hazard rate(HR)(95%CI):0.32(0.13-0.82),0.32(0.13-0.82),3.86(1.34-11.12),4.61(1.33-16.02),4.06(1.55-10.61),all P<0.05),whereas SUV_(max) and SUV_(max)/SUV_(mean)2.5 were the independent prognostic factors for OS(HR:8.04(1.96-32.87),2.87(1.09-7.51),P values:0.004,0.032).ConclusionHI-1,HI-2,and SUV_(max)/SUV_(mean)2.5 have prognostic value for CMM,while the value of AUC-CSH heterogeneity parameters are not significant.

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]