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 mean2.5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 mean2.5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 mean2.5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 mean2.5, 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 mean2.5 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 mean2.5 have prognostic value for CMM, while the value of AUC-CSH heterogeneity parameters are not significant.
谭千倩,赵莲君,何健,等. 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 [J]. 中华核医学与分子影像杂志,2025,45(03)：154-158.
DOI:10.3760/cma.j.cn321828-20240511-00163版权归中华医学会所有。
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除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
谭千倩：研究实施、论文撰写；赵莲君、何健：统计学分析；来瑞鹤：研究指导、论文修改、经费支持
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