18F-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

目的探讨18F-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:SUVmax、SUVmean、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SUVmax、SUVmean、TMTV、TLG预测PFS/OS的最佳界值分别为4.63/4.77、3.31/3.31、8.22 cm3/22.32 cm3和18.22 g/51.37 ...     

18F-FDG PET/CT对化疗中期弥漫性大B细胞淋巴瘤患者预后判断的价值

目的 探讨18F-氟脱氧葡萄糖（FDG）PET/CT参数对化疗中期弥漫性大B细胞淋巴瘤（DLBCL）患者预后判断的价值。 方法 回顾性分析2011年1月至2020年1月河北医科大学第四医院112例DLBCL患者的临床资料和化疗3~4周期后（中期）18F-FDG PET/CT显像资料，其中男性60例、女性52例，年龄16~79（49.5±16.6）岁。以最大标准化摄取值（SUV_max）的40%为阈值勾画感兴趣区（ROI），获得病灶的SUV_max、全身所有病灶总的代谢肿瘤体积（TMTV）、总的糖酵解总量（TTLG），在CT图像上测量6个靶病灶的最大垂直径乘积之和（SPD）。采用受试者工作特性（ROC）曲线计算各代谢参数和解剖测量参数预测患者无进展生存（PFS）期和总生存（OS）期的最佳临界值。采用Kaplan-Meier法进行生存分析，采用Log-rank检验进行单因素分析，采用Cox比例风险回归模型对单因素分析有统计学意义的预后影响因素进行多因素分析。 结果 112例DLBCL患者中，在随访期间25例（22.3%）出现疾病进展、14例（12.5%）死亡。18F-FDG PET/CT 参数SUV_max、TMTV、TTLG和SPD预测DLBCL患者PFS期的最佳临界值分别为1.75、6.40 cm3、9.30 g和3.53 cm2，曲线下面积（AUC）分别为0.712、0.652、0.680、0.728（95%CI:0.596~0.829、0.518~0.787、0.549~0.811、0.619~0.837，均P<0.05）；预测OS期的最佳临界值分别为3.75、17.80 cm3、19.05 g和5.67 cm2，AUC分别为0.727、0.686、0.727、0.757（95%CI:0.578~0.877、0.512~0.861、0.559~0.896、0.622~0.891，均P<0.05）。单因素分析结果显示，年龄、美国东部肿瘤协作组（ECOG）评分、国际预后指数评分、美国国家综合癌症网络-国际预后指数评分、Deauville评分以及SUV_max、TMTV、TTLG、SPD均是DLBCL患者PFS期（χ2=5.152~22.998，均P<0.05）和OS期的影响因素（χ2=4.735~19.687，均P<0.05）；乳酸脱氢酶（LDH）水平是OS期的影响因素（χ2=4.154，P<0.05），但不是PFS期的影响因素（χ2=2.223，P>0.05）。多因素分析结果显示，年龄、ECOG评分、TTLG是影响DLBCL患者PFS期的独立危险因素（HR=0.331、0.262、0.281，95%CI:0.145~0.753、0.113~0.605、0.119~0.666，均P<0.01）；LDH水平、SPD是影响DLBCL患者OS期的独立危险因素（HR=0.594、1.922，95%CI:0.360~0.979、1.123~3.290，均P<0.05）。 结论 18F-FDG PET/CT参数 SUV_max、TMTV、TTLG、SPD对化疗中期DLBCL患者预后有较好的判断价值。     

基线18F-FDG PET/CT代谢参数对伴有转移的食管鳞状细胞癌放化疗患者预后的预测价值

目的 探究治疗前18F-氟脱氧葡萄糖（FDG） PET/CT显像原发灶与转移灶代谢参数对接受放化疗的食管鳞状细胞癌（ESCC）患者预后的预测价值。 方法 回顾性分析2013年11月至2021年4月于青岛大学附属医院行18F-FDG PET/CT检查的106例接受放化疗的ESCC患者的临床资料,其中男性98例、女性8例,年龄（63.9±8.8）岁。临床因素包括年龄、性别、原发灶位置、临床分期、分化程度和治疗方式。以40%最大标准化摄取值（SUV_max）作为阈值,勾画治疗前食管癌原发病灶及转移灶的感兴趣区（ROI）,获得相应的食管癌原发灶的SUV_max,原发灶的肿瘤代谢体积（MTV_p）,原发灶的病灶糖酵解总量（TLG_p）和全身病灶的MTV（MTV_wb）,全身病灶的TLG（TLG_wb）,转移灶与原发灶SUV_max,MTV,TLG的比值（R-SUV_max、R-MTV、R-TLG）。采用Kaplan-Meier法及Log-Rank检验进行单因素分析,采用Cox比例风险模型进行多因素分析,预测影响患者无进展生存（PFS）期及总生存（OS）期的预后因素。 结果 单因素分析结果显示,T分期、MTV_p、TLG_p、MTV_wb、TLG_wb及R-TLG是影响接受放化疗ESCC患者PFS期和OS期的危险因素（χ2=4.105~27.992,均P<0.05）;多因素分析结果显示,T分期及R-TLG为ESCC患者PFS期（HR=2.210,95%CI:1.307~3.737,P=0.003;HR=3.118,95%CI:1.414~6.875,P=0.005）及OS期（HR=1.885,95%CI:1.072~3.317,P=0.028;HR=2.584,95%CI:1.186~5.629;P=0.017）的独立预后因素。联合T分期及R-TLG将患者分为低、中、高危3组,结果显示,各组患者间PFS期及OS期的差异均有统计学意义（χ2=38.392、19.857,均P<0.001）。 结论 ESCC患者放化疗前T分期和18F-FDG PET/CT代谢参数R-TLG为PFS期及OS期的独立预后因素。     

~(18)F-FDG PET/CT显像在霍奇金淋巴瘤分期及疗效评价的应用

目的探讨18F-FDG PET/CT显像对霍奇金淋巴瘤(hodgkin’s lymphoma,HD)的临床分期、疗效评价、监测复发及提示预后方面的应用价值。方法回顾性分析我院2005年~2011年病理活检和免疫组化确诊的51例HD患者的18F-FDG PET/CT显像结果,应用无进展生存(progression-free survival,PFS)期及总体生存(overall survival,OS)期作为随访指标,进行疗效评价。组间PFS率及OS率的比较采用X2检验;患者的生存分析采用Kaplan-Meier方法。结果23例HD患者于治疗前行18 F-FDG PET/CT显像,17.4%(4/23)患者分期上调。51例患者在完成全部治疗后行18 FFDG PET/CT显像,PET/CT显像结果阳性患者19例,阴性患者32例。阳性者及阴性者的中位PFS期分别为10个月和38个月,2年PFS率分别为5.2%(1/19)和64.5%(20/31),差异有统计学意义(X2=16.978,P=0.000);中位OS期分别为19个月和39个月,3年OS率分别为10.5%(2/19)和51.6%(16/31),差异有统计学意义(X2=8.631,P=0.003)。治疗后PET/CT显像的阳性预测值及阴性预测值分别为94.7%(18/19)、90.6%(29/32)。结论18 F-FDG PET/CT是HD患者明确分期、评价疗效、监测复发及提示预后方面的可靠方法,有助于临床早期判断疗效及制定个体化治疗方案。     

基线18F－FDG PET/CT评估抗PD－1免疫治疗转移性黑色素瘤患者的预后

目的探讨基线18F-FDG PET/CT代谢参数对经抗程序性细胞死亡蛋白1(PD-1)治疗的转移性恶性黑色素瘤的预后价值。方法回顾性分析南京大学医学院附属鼓楼医院2017年6月至2020年10月经病理学确诊为转移性恶性黑色素瘤的29例患者[男15例、女14例, 年龄(59.1±13.0)岁]的临床资料, 所有患者于抗PD-1免疫治疗前行基线18F-FDG PET/CT检查。获取18F-FDG PET/CT参数:SUVmax、骨髓/肝SUVmax比值(BLR)、脾/肝SUVmax比值(SLR), 以SUV的阈值(40%SUVmax)作为体素边界, 测总肿瘤代谢体积(TMTV)、病灶糖酵解总量(TLG)。以各PET参数中位数为阈值将患者分为2组(≥中位数与<中位数组), 采用Kaplan-Meier生存曲线和Cox比例风险模型分析组间总生存(OS)的差异。结果患者中位随访时间15.0个月。29例患者中13例死亡, 中位OS为26.0(95%CI: 20.4～31.6)个月。SUVmax、TMTV、TLG、BLR和SLR的中位数分别为6.2、8.2 cm3、38.6 g、0.82和0....     

初诊多发性骨髓瘤患者18F-FDG PET/CT影像学表现与高危细胞遗传学异常的相关性及预后评估

目的 探讨初诊多发性骨髓瘤（MM）患者的18F-氟脱氧葡萄糖（FDG） PET/CT影像学表现与高危细胞遗传学异常（HRCA）的相关性及二者联合应用于MM患者预后评估中的价值。 方法 回顾性分析2016年6月至2020年11月于汕头市中心医院经骨髓组织病理学检查和实验室检查确诊为MM并于治疗前行18F-FDG PET/CT显像的44例患者的临床资料和影像学资料,其中男性23例、女性21例,年龄38~91（61.1±9.6）岁。根据荧光原位杂交检测结果将患者分为有HRCA组和无HRCA组;根据国际骨髓瘤工作组发布的修订版国际分期系统（R-ISS）分期标准将患者分为Ⅰ期+Ⅱ期和Ⅲ期2组;根据Mayo骨髓瘤分层级风险调整治疗（mSMART）3.0危险度分层标准将患者分为标危组和高危组。分析所有患者的18F-FDG PET/CT显像资料,根据局灶病变（FLs）个数≤3或>3、最大标准化摄取值（SUV_max）≤4.2或>4.2和有无髓外病变（EMD）分别将患者各分为2组。随访结束后统计患者的无进展生存（PFS）期和总生存（OS）期。采用χ2检验比较MM患者的18F-FDG PET/CT影像学表现与临床特征、HRCA和分期的差异;采用多因素Logistic回归分析MM患者HRCA、R-ISS分期和mSMART 3.0分期的独立危险因素;采用Kaplan-Merier和Log-rank检验比较组间PFS期和OS期的差异;采用Cox比例风险回归模型分析MM患者PFS期和OS期的独立预后不良因素。 结果 FLs个数≤3或>3在不同R-ISS分期、不同mSMART 3.0分期和有无HRCA组间的差异均有统计学意义（χ2=4.919、8.472、8.167,均P<0.05）;有无EMD在不同mSMART 3.0分期和有无HRCA组间的差异均有统计学意义（χ2=4.061、6.808,均P<0.05）。FLs个数>3是HRCA、R-ISS分期和mSMART 3.0分期的独立危险因素（OR=10.952、5.000、10.714,95%CI:1.195~100.393、1.127~22.181、2.269~50.598,均P<0.05）。有无EMD和有无HRCA组间PFS期和OS期的差异均有统计学意义（PFS期:χ2=8.572、9.023,均P<0.01;OS期:χ2=6.030、4.877,均P<0.05）。EMD是PFS期和OS期的独立预后不良因素（OR=4.466、6.520,95%CI:1.084~18.396、1.174~36.211,均P<0.05）;HRCA是PFS期的独立预后不良因素（OR=8.458,95%CI:1.671~42.812,P<0.05）。截至随访结束,无EMD且无HRCA或仅存在两者之一的患者,均未达到中位PFS期和中位OS期;同时存在EMD和HRCA的患者中位PFS期为11个月（χ2=20.903,P<0.001）,中位OS期为17个月（χ2=10.656,P<0.01）。 结论 初诊MM的患者的18F-FDG PET/CT影像学表现与HRCA存在相关性,二者联合应用对MM患者的预后评估有一定的预测价值。     

基线18F-FDG PET/CT代谢参数在局部晚期宫颈癌同步放化疗中的预后预测价值

目的探讨基线18F-FDG PET/CT肿瘤代谢参数在局部晚期宫颈癌(LACC)同步放化疗(CCRT)中的预后预测价值。方法回顾性分析2015年9月至2021年10月山东第一医科大学附属肿瘤医院接受CCRT的LACC患者180例(年龄:22～76岁)。患者治疗前均接受基线18F-FDG PET/CT检查, 利用42%SUVmax作为固定阈值自动勾画病灶边界, 提取肿瘤代谢参数, 包括肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)、SUVmax和SUVmean。采用ROC曲线分析获得预测无进展生存(PFS)的最佳界值, 采用Kaplan-Meier法进行生存分析并行log-rank检验, 采用多因素Cox比例风险回归模型对PFS进行预后分析。结果中位随访19.1个月, 54例(30.0%, 54/180)患者肿瘤进展。ROC曲线分析示, MTV预测PFS的最佳界值为31.145 ml, AUC为0.641;临床因素中腹主动脉旁淋巴结(PALN)转移AUC最高(0.589), 其次为国际妇产科联盟(FIGO)分期(AUC为0.581)。MTV<31.145 ml(n=88)和MTV...     

术前^18F-FDG PET/CT显像对非小细胞肺癌患者中远期预后的预测价值

目的 探讨非小细胞肺癌(NSCLC)根治性切除术术前^18F-脱氧葡萄糖(FDG) PET/CT显像对患者中远期预后的预测价值.方法 回顾性分析2010年4月至2016年8月间北京医院收治的70例行根治性手术且术前1个月内行^18F-FDG PET/CT显像的初诊NSCLC患者资料,其中男35例,女35例,中位年龄64岁.分析患者肺癌原发灶及纵隔或肺门淋巴结的PET/CT影像学征象[原发灶大小及最大标准摄取值(SUVmax)、纵隔或肺门高代谢淋巴结(HML) SUVmax及分布类型]并随访.研究终点为总生存(OS)期和无进展生存(PFS)期.采用Kaplan-Meier法、log-rank检验和Cox比例风险回归模型分析探讨患者生存的预后因素.结果 随访0.9~8.2年.70例患者中,31.4% (22/70)进展,24.3%(17/70)死亡.对于OS期,术前NSCLC原发灶SUVmax≥10与<10者(4.6和7.6年)、原发灶大小>3 cm与≤3 cm者(4.8和7.4年)、纵隔或肺门HML分布于肺癌同侧与位于双侧或无HML者(4.4和7.4年)、纵隔或肺门HML SUVmax≥5.0与<5.0者(3.8和7.3年)的差异均有统计学意义(x^2值:10.135~ 15.238,均P<0.01);上述组别患者PFS期(3.9和6.7年、3.8和6.6年、3.8和6.4年、3.3和6.3年)的差异亦有统计学意义(x^2值:8.410~ 14.600,均P<0.01).Cox多因素分析显示,原发灶大小和SUVmax是预测NSCLC术后OS期及PFS期的独立危险因素(均P<0.01),纵隔或肺门HML分布类型对预测NSCLC的OS期有边际意义(P=0.051).结论 NSCLC根治术术前^18F-FDG PET/CT显像中的原发灶大小和SUVmax对NSCLC术后生存期有重要的预测价值;纵隔或肺门HML分布类型对术后NSCLC的预后可能有预测价值.     

基线18F-FDG PET/CT 在结外自然杀伤/T 细胞淋巴瘤患者预后评估中的价值

目的 探讨结外自然杀伤/T细胞淋巴瘤（ENKTL）患者治疗前18F-氟脱氧葡萄糖（FDG）PET/CT代谢参数在其预后评估中的价值。 方法 回顾性分析37例在南京大学医学院附属鼓楼医院确诊为ENKTL患者的临床资料,其中男性27例、女性10例,中位年龄46（21~76）岁。根据患者不同生存状态分为无进展组、进展组和生存组、病死组。所有患者行PET/CT显像,测量各组患者的最大标准化摄取值（SUV_max）,并以SUV>40% SUV_max的体素边界作为临界值,分别测量全身肿瘤代谢体积（MTV）和全身病灶糖酵解总量（TLG）。采用Mann-Whitney U检验评估2组的PET参数差异。应用受试者工作特征（ROC）曲线获得SUV_max、全身MTV和全身TLG的最佳临界值,根据PET参数最佳临界值将患者重新分为以临界值为界的不同组。采用Kaplan-Meier法及Log-rank检验预测2组间总生存期（OS）和无进展生存期（PFS）的差异。采用单因素分析法评估PET参数和临床变量的预后意义。采用Cox比例风险模型评估PET参数是否为OS和PFS的独立预后危险因素。 结果 无进展组的SUV_max、全身MTV和全身TLG的M（P₂₅,P₇₅）分别为10.8（6.9,14.4）、13.1（7.0,16.7）cm3和53.81（34.1,97.4）,进展组分别为11.7（9.5,17.8）、29.4（17.3,69.2）cm3和183.5（125.1,725.3）。进展组的SUV_max、全身MTV和全身TLG均高于无进展组,且差异均有统计学意义（Z=?2.60、?3.28、?3.25,均P<0.01）。生存组的SUV_max、全身MTV和全身TLG的M（P₂₅,P₇₅）分别为9.9（6.7,12.7）、10.2 （6.7,17.1）cm3和52.4（33.4,90.4）,病死组分别为12.3（9.9,18.7）、25.5（13.4,113.6 ）cm3和187.8（110.0,1006.9）。病死组的SUV_max、全身MTV和全身TLG均高于生存组,且差异均有统计学意义（Z=?3.37、?3.11、?3.76,均P<0.01）。SUV_max、全身MTV和全身TLG以临界值为界的不同组患者OS的差异均有统计学意义（χ2=5.12、13.07、15.51,均P<0.05）;全身MTV和全身TLG以临界值为界的不同组的患者PFS的差异均有统计学意义（χ2=17.55、16.21,均P<0.05）。ROC曲线分析结果显示,SUV_max、全身MTV和全身TLG的最佳临界值分别为9.03、19.17 cm3和99.95。单因素分析结果表明,韩国预后指数评分>2分、Ann Arbor分期Ⅲ/Ⅳ期、SUV_max>9.03、全身MTV>19.17 cm3和全身TLG>99.95是OS的预后危险因素,Ann Arbor分期Ⅲ/Ⅳ期、全身MTV>19.17 cm3和全身TLG>99.95是PFS的预后危险因素。多因素分析结果表明,全身MTV>19.17 cm3和全身TLG>99.95是OS和PFS的独立预后危险因素。 结论 18F-FDG PET/CT代谢参数全身MTV和全身TLG能够评估ENKTL患者的预后,而SUV_max对于ENKTL患者的预后评估价值不大。     

基于18F-FDG PET代谢参数及临床参数的列线图生存预测模型预测弥漫大B细胞淋巴瘤患者预后的价值

目的 构建基于18F-氟脱氧葡萄糖（FDG）PET代谢参数及临床参数的列线图生存预测模型，并验证其对弥漫大B细胞淋巴瘤（DLBCL）患者预后的预测价值。 方法 回顾性分析2011年3月至2019年11月于南京大学医学院附属鼓楼医院以及南京医科大学第一附属医院经组织病理学检查确诊的383例未经治疗的DLBCL患者的18F-FDG PET/CT影像学资料和临床资料，其中男性204例、女性179例，年龄19~93（47.3±14.9）岁。按照7∶3的比例采用随机数字表法将患者分为训练组（n=268例）和验证组（n=115例）。勾画并计算患者总肿瘤代谢体积（TMTV）和病灶糖酵解总量（TLG）。采用Kaplan Meier生存分析、单因素和多因素Cox比例风险回归模型对患者无进展生存（PFS）期及总生存（OS）期进行预后分析并构建生存预测模型。通过训练组和验证组的校准曲线、一致性指数（C-index）以及临床决策曲线分析（DCA）对预测模型进行评估。 结果 训练组单因素分析结果显示，年龄、乳酸脱氢酶（LDH）水平、美国东部肿瘤协作组行为状态（ECOG PS）评分、Ann Abor分期、大包块、TMTV及TLG为预测PFS期的危险影响因素（HR=1.670~3.277，均P<0.05）；年龄、LDH水平、B症状、ECOG PS评分、Ann Abor分期、大包块、TMTV及TLG为预测OS期的危险影响因素（HR=1.661~4.193，均P<0.05）。训练组多因素分析结果表明，年龄、LDH水平、Ann Abor分期及TLG是预测DLBCL患者PFS期和OS期的独立影响因素（HR=1.589~3.367，均P<0.05）。校准曲线显示，该预测模型具有较好的预测一致性；C-index评估结果显示，训练组和验证组预测模型具有较高的准确性（PFS期:0.724对0.762； OS期:0.749对0.753）。临床DCA结果表明，预测模型可以给患者带来更多的临床获益。 结论 基于18F-FDG PET代谢参数TLG及临床参数（年龄、LDH水平、Ann Abor分期）生存预测模型能够很好地对DLBCL患者进行预后评估，为精准个性化治疗提供可能。     

Baseline metabolic tumor burden on FDG PET/CT scans predicts outcome in advanced NSCLC patients treated with immune checkpoint inhibitors

We aimed to evaluate if imaging biomarkers on FDG PET are associated with clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). In this retrospective monocentric study, we included 109 patients with advanced NSCLC who underwent baseline FDG PET/CT before ICI initiation between July 2013 and September 2018. Clinical, biological (including dNLR = neutrophils/[leukocytes minus neutrophils]), pathological and PET parameters (tumor SUVmax, total metabolic tumor volume [TMTV]) were evaluated. A multivariate prediction model was developed using Cox models for progression-free survival (PFS) and overall survival (OS). The association between biomarkers on FDG PET/CT and disease clinical benefit (DCB) was tested using logistic regression. Eighty patients were eligible. Median follow-up was 11.6 months (95%CI 7.7–15.5). Sixty-four and 52 patients experienced progression and death, respectively. DCB was 40%. In multivariate analyses, TMTV > 75 cm3 and dNLR > 3 were associated with shorter OS (HR 2.5, 95%CI 1.3–4.7 and HR 3.3, 95%CI 1.6–6.4) and absence of DCB (OR 0.3, 95%CI 0.1–0.9 and OR 0.4, 95%CI 0.2–0.9). Unlike TMTV, dNLR was a significant prognostic factor for PFS (HR 1.9, 95%CI 1.1–3.3) along with anemia (HR 1.9, 95%CI 1.2–3.8). No association was observed between tumor SUVmax and PFS or OS. Baseline tumor burden (TMTV) on FDG PET/CT scans and inflammatory status (dNLR) were associated with poor OS and absence of DCB for ICI treatment in advanced NSCLC patients, unlike tumor SUVmax, and may be used together to improve the selection of appropriate candidates.     

Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

Background

[¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) imaging has been employed as a non-invasive diagnostic tool for malignant tumors. Total lesion glycolysis (TLG) on FDG-PET is calculated by multiplying the mean standardized uptake value (SUVmean) by the tumor volume. Unlike the maximum standardized uptake value (SUVmax), which represents the point of greatest metabolic activity within tumors, TLG has been suggested to reflect global metabolic activity in whole tumors.

Methods

We retrospectively examined whether or not FDG-PET measurements, including SUVmean, SUVmax, and TLG, could predict progression-free survival (PFS) or overall survival (OS) in patients with non-small cell lung cancer (NSCLC) receiving chemotherapy.

Results

This study involved 81 consecutive patients with NSCLC who received chemotherapy. All of the patients underwent FDG-PET examination before treatment. SUVmean, SUVmax, and TLG on FDG-PET were significantly associated with gender, smoking status, and tumor histology. With adjustment for several other variables, Cox regression analysis showed that TLG was significantly prognostic for both PFS [hazard ratio = 2.34; 95% confidence interval, 1.18–4.64; P = 0.015] and OS (hazard ratio = 2.80; 95% confidence interval, 1.12–6.96; P = 0.003), whereas SUVmean and SUVmax had no significant association with PFS (P = 0.693 and P = 0.322, respectively) or OS (P = 0.587 and P = 0.214, respectively).

Conclusions

Our findings suggest that TLG may be more useful than SUVmean and SUVmax for predicting PFS and OS in NSCLC patients receiving chemotherapy. The TLG measurement on FDG-PET imaging could be routinely recommended to advanced NSCLC patients.     

Pretreatment quantitative 18F-FDG PET/CT parameters as a predictor of survival in adenoid cystic carcinoma of the salivary glands

PurposeThe aim of this study was to determine the unique prognostic value of quantitative ¹⁸F-FDG PET/CT parameters to assess progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with salivary gland adenoid cystic carcinoma (ACC).MethodsWe performed a retrospective study including 23 patients (15 men, 8 women; median age, 58 years; range, 21–91 years) with salivary gland ACC between January 2009 and October 2017 who underwent ¹⁸F-FDG PET/CT scan prior to treatment. Maximum, mean, peak, tumor-to-mediastinal blood pool and tumor-to-liver standardized uptake values (SUV_max, SUV_mean, SUV_peak, SUV_ratio[med] and SUV_ratio[liver]), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained from ¹⁸F-FDG PET/CT. The prognostic value of quantitative ¹⁸F-FDG PET/CT parameters and other clinicopathological variables were evaluated utilizing the Cox proportional regression analysis.ResultsThe 3-year and 5-year OS for all the patients were 90.9%, and 62.3%, respectively. Log rank test determined that the SUV_ratio[med], SUV_ratio[liver], MTV and TLG were predictive factors of DMFS, PFS, and OS (p < 0.05), furthermore, SUV_max, minor salivary gland tumors and DM at initial diagnosis (M1 stage) were predictor for PFS; M1 stage and overall stage 3–4 predicted DMFS (all p < 0.05). Cox regression analyses confirmed that the higher SUV_ratio[med], SUV_ratio[liver], MTV, and TLG values predicted DMFS, PFS and OS independently, whereas SUV_max was an independent predictor of only PFS (p < 0.05).ConclusionsThe pretreatment metabolic ¹⁸F-FDG PET/CT parameters may reflect tumor aggressiveness in patients with salivary gland ACC and may potentially be utilized as a prognostic biomarker.     

Metabolic response evaluated by 18F-FDG PET/CT as a potential screening tool in identifying a subgroup of patients with advanced non-small cell lung cancer for immediate maintenance therapy after first-line chemotherapy

Purpose

Among patients with advanced non-small cell lung cancer (NSCLC), identification of a subgroup of patients for immediate maintenance treatment after first-line chemotherapy has great importance in improving survival. The purpose of this study was to investigate whether the metabolic responses evaluated by ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) may be a potential screening tool for identifying patients with early disease progression who may benefit from immediate maintenance treatment.

Methods

A total of 52 patients with advanced NSCLC (36 men and 16 women, mean age 57.2?±?10.6 years) who underwent baseline and follow-up ¹⁸F-FDG PET/CT after four cycles of first-line chemotherapy were enrolled. Maximum standardized uptake value (SUV_max), SUV_peak, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the tumour lesions were measured and percentage decrease of the parameters was calculated. The prognostic significance of percentage decrease of these parameters and other clinical variables related to progression-free survival (PFS) and overall survival (OS) were assessed by Cox proportional hazards regression analysis. Receiver-operating characteristic (ROC) curve analysis was used to define the optimal cut-off value of percentage decrease of the parameters that could distinguish between early (PFS?<?6 months) and late (PFS?≥?6 months) disease progression groups.

Results

Multivariate analysis showed that percentage decrease of TLG [hazard ratio per 10 % decrease?=?1.030, 95 % confidence interval (CI)?=?1.012–1.048, p?=?0.001) was a significant predictor of PFS and OS. ROC curves identified a 50.0 % decrease in TLG as the optimal cut-off value to distinguish disease progression groups. Positive and negative predictive values of the optimal TLG value for selecting patients with late disease progression were 36.4 and 100.0 %, respectively.

Conclusion

The percentage decrease in TLG of measurable tumour lesions may be a potential parameter to appropriately identify a subgroup of patients for immediate maintenance treatment after first-line chemotherapy in patients with advanced NSCLC.     

Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma

Objective

Primary brain lymphoma is an aggressive extranodal non-Hodgkin lymphoma with poor prognosis. Many possible prognostic factors are investigated with controversial results, but possible prognostic role of 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) features remains unclear. Our aim was to study the metabolic behavior of brain lymphoma at 18F-FDG PET/CT and the prognostic impact of qualitative and semiquantitative PET/CT parameters.

Methods

Between 2006 and 2018, 52 patients (26 females and 26 males; mean age: 61 years) with histologically confirmed diagnosis of brain lymphoma who underwent 18F-FDG PET/CT for staging before any treatment were included. PET images were qualitatively and semiquantitatively analyzed by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). The Kaplan–Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS) times. Cox regression models were performed to determinate the relation between qualitative and semiquantitative PET/CT features and OS and PFS.

Results

Thirty-nine patients had positive 18F-FDG PET/CT showing 18F-FDG uptake (mean SUVbw of 18.2; SUVlbm of 13.9; SUVbsa of 5; MTV of 14.8; TLG of 153) at the corresponding cerebral lesion; the remaining 13 were not 18F-FDG avid. Relapse or progression of disease occurred in 22 patients with an average time of 9.7 months; death occurred in 18 patients with an average of 7.9 months. There was no difference in PFS and OS between baseline PET/CT positive and negative groups or considering SUVbw, SUVlbm, and SUVbsa. PFS and OS was significantly shorter in patients with MTV ≥?9.8 cm³ (p?=?0.037 and p?=?0.022, respectively) and TLG ≥?94 (p?=?0.045 and p?=?0.0430, respectively).

Conclusions

18F-FDG avidity was noted in 75% of cases. Only metabolic tumor parameters (MTV and TLG) were independently correlated with PFS and OS.

     

Prognostic implication of extrarenal metabolic tumor burden in advanced renal cell carcinoma treated with targeted therapy after nephrectomy

Objective

In the era of targeted therapy for advanced renal cell carcinoma (RCC), appropriate prognosis prediction is necessary for optimal therapy with or without cytoreductive surgery. We evaluated prognostic implication of extrarenal metabolic tumor burden in nephrectomized patients with advanced RCC.

Methods

Forty-four patients with advanced RCC who underwent ¹⁸F-fluorodeoxyglucose PET/CT were retrospectively enrolled. The patients were treated with nephrectomy and targeted therapy. On PET/CT image of each patient, maximal standardized uptake value (SUV_max) of lesions were measured, and metabolic tumor burden was measured as total lesion glycolysis (TLG) by multiplying tumor volume and mean SUV. An overall TLG was calculated as the sum of those of all lesions. The prognostic value of PET parameters (SUV_max and TLG), and established major clinical factors (serum hemoglobin and corrected calcium, and number of metastatic sites) were tested with regard to overall survival.

Results

Among 44 patients, 8 died during mean follow-up time of 21.9 ± 17.7 months. On FDG PET/CT, a total of 250 lesions were analyzed. In univariate analyses, SUV_max, TLG, number of metastatic sites, serum hemoglobin and corrected calcium were significant prognostic factors. Among them, TLG remained as an independent prognostic factor in a multivariate analysis (P = 0.038). In subgroup analyses, TLG was still a significant prognostic factor in patients treated with sunitinib only and in patients on the first staging as well as restaging.

Conclusions

Extrarenal metabolic tumor burden is a significant prognostic factor in advanced RCC patients treated with targeted therapy. In selection of candidates for cytoreductive surgery, the measurement of metabolic tumor burden may be effective.     

Metabolic Tumor Volume Measured by F-18 FDG PET/CT can Further Stratify the Prognosis of Patients with Stage IV Non-Small Cell Lung Cancer

Purpose

This study aimed to further stratify prognostic factors in patients with stage IV non-small cell lung cancer (NSCLC) by measuring their metabolic tumor volume (MTV) using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).

Materials and Methods

The subjects of this retrospective study were 57 patients with stage IV NSCLC. MTV, total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured on F-18 FDG PET/CT in both the primary lung lesion as well as metastatic lesions in torso. Optimal cutoff values of PET parameters were measured by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier survival curves were used for evaluation of progression-free survival (PFS). The univariate and multivariate Cox proportional hazards models were used to select the significant prognostic factors.

Results

Univariate analysis showed that both MTV and TLG of primary lung lesion (MTV-lung and TLG-lung) were significant factors for prediction of PFS (P < 0.001, P = 0.038, respectively). Patients showing lower values of MTV-lung and TLG-lung than the cutoff values had significantly longer mean PFS than those with higher values. Hazard ratios (95 % confidence interval) of MTV-lung and TLG-lung measured by univariate analysis were 6.4 (2.5–16.3) and 2.4 (1.0–5.5), respectively. Multivariate analysis revealed that MTV-lung was the only significant factor for prediction of prognosis. Hazard ratio was 13.5 (1.6–111.1, P = 0.016).

Conclusion

Patients with stage IV NSCLC could be further stratified into subgroups of significantly better and worse prognosis by MTV of primary lung lesion.     

Prognostic Significance of Volume-based Metabolic Parameters by 18F-FDG PET/CT in Gallbladder Carcinoma

Purpose

We investigated the prognostic values of volume-based metabolic parameters by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) in gallbladder carcinoma patients and compared them with other prognostic parameters.

Materials and Methods

We enrolled 44 patients, who were initially diagnosed with gallbladder carcinoma and undergoing ¹⁸F-FDG PET/CT. Various metabolic volume-based PET parameters of primary tumors, including maximum and average standardized uptake values (SUV_max, SUV_avg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were measured in gallbladder carcinoma patients using mediastinal blood pool activity as a threshold SUV for determining the tumor boundaries. Overall survival analysis was performed using the Kaplan-Meier method with PET parameters and other clinical variables. For determining independent prognostic factors, Cox proportional hazards regression analysis was performed.

Results

Of the 44 enrolled patients, cancer- or treatment-related death occurred in 30 (68.2 %). The mean clinical follow-up period was 22.2 ± 10.4 m (range, 0.6-35.9 m). Univariate analysis demonstrated that clinical or pathologic TNM stage (P < 0.001), treatment modality (P < 0.001), MTV (cutoff = 135 cm³, P = 0.001), and TLG (cutoff = 7,090, P < 0.05) were significant prognostic factors. In multivariate analysis, both clinical or pathologic TNM stage [hazard ratio (HR) = 2.019 (I vs II), 21.287 (I vs III), and 24.354 (I vs IV); P = 0.001) and TLG (HR = 2.930; P < 0.05) were independent prognostic factors for predicting overall survival.

Conclusions

In gallbladder cancer, TLG of the primary tumor, a volume-based metabolic parameter, is a significant independent prognostic factor for overall survival in conjunction with the clinical or pathological TNM stage.