基线^(18)F-FDG PET/CT评估原发性恶性黑色素瘤患者的预后

Prognostic value of pretreatment ^(18)F-FDG PET/CT in patients with primary malignant melanoma

目的探讨基线^(18)F-FDG PET/CT原发灶代谢参数对原发性恶性黑色素瘤的预后意义。方法回顾性分析南京大学医学院附属鼓楼医院2014年1月至2019年8月间35例(男21例、女14例,年龄35~85岁)确诊为原发性恶性黑色素瘤患者的临床资料,所有患者在术前均行^(18)F-FDG PET/CT检查。获取^(18)F-FDG PET/CT原发灶代谢参数:SUV_(max)、SUV_(mean)、SUV峰值(SUV_(peak));以40%SUV_(max)阈值作为体素边界,测量原发灶肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)。采用ROC曲线得出PET参数判断疾病进展的最佳阈值。采用Kaplan-Meier方法和Cox比例风险回归模型分析黑色素瘤特异性生存(MSS)和无进展生存(PFS)与PET代谢参数间的关系。结果中位随访15.4个月,20例病情进展,7例死亡。ROC曲线分析示,SUV_(max)、SUV_(mean)、SUV_(peak)、MTV和TLG的最佳阈值分别为3.95、2.45、2.65、3.60 cm^(3)和14.85 g(AUCs:0.742、0.790、0.728、0.655、0.693;P值:0.016、0.004、0.022、0.121、0.053)。Kaplan-Meier法及log-rank检验表明,SUV_(max)、SUV_(mean)、SUV_(peak)、MTV和TLG是原发性恶性黑色素瘤PFS的预后危险因素(χ^(2)值:4.06~8.35,均P<0.05)。多因素分析示,MTV[风险比(HR)=3.09,95%CI:1.08~8.86,P=0.036]和TLG(HR=3.36,95%CI:1.11~10.14,P=0.031)是PFS的独立预后危险因素,但不是MSS的预后危险因素(HR=5.14,P=0.080)。结论SUV_(max)、SUV_(mean)、SUV_(peak)对原发性恶性黑色素瘤患者疾病进展有一定的预测价值,MTV和TLG是原发性黑色素瘤疾病进展的最佳预测因素。

Objective To assess the prognostic value of pretreatment ^(18)F-FDG PET/CT metabolic parameters in patients with primary melanoma.Methods A retrospective analysis comprised of 35 patients(21 males,14 females,age:35-85 years;from January 2014 to August 2019;Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School)who were newly-diagnosed primary melanoma with preoperative ^(18)F-FDG PET/CT was conducted.^(18)F-FDG PET/CT metabolic parameters including SUV_(max),SUV_(mean),_(peak) of SUV(SUV_(peak))were obtained.Metabolic tumor volume(MTV)and total lesion glycolysis(TLG)of primary focus were measured automatically using the threshold of 40%SUV_(max).The optimal thresholds of PET parameters were obtained by using ROC curve analysis.The associations between melanoma-specific survival(MSS),progression-free survival(PFS)and PET/CT metabolic parameters were assessed using Kaplan-Meier method and Cox proportional hazards model.Results The median follow-up was 15.4 months,and 20 patients showed disease progression and 7 died.The cut-off values for SUV_(max),SUV_(mean),SUV_(peak),MTV and TLG were 3.95,2.45,2.65,3.60 cm^(3) and 14.85 g,respectively(AUCs:0.742,0.790,0.728,0.655,0.693;P values:0.016,0.004,0.022,0.121,0.053).Kaplan-Meier method and log-rank test showed that SUV_(max),SUV_(mean),SUV_(peak),MTV and TLG were predictors of PFS(χ^(2) values:4.06-8.35,all P<0.05).Multivariate analysis showed that MTV(hazard ratio(HR)=3.09,95%CI:1.08-8.86,P=0.036)and TLG(HR=3.36,95%CI:1.11-10.14,P=0.031)were significant predictors of PFS but not for MSS(HR=5.14,P=0.080).Conclusions SUV_(max),SUV_(mean) and SUV_(peak) of primary focus may help for predicting PFS of patients with primary melanoma.MTV and TLG of primary focus may be the best to predict PFS of primary melanoma.