1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 3235, Baltimore, MD 21287.
AJR Am J Roentgenol. 2015 May;204(5):1093-9. doi: 10.2214/AJR.14.13156.
The purpose of this study is to evaluate the performance of PET-derived parameters as prognostic markers for overall survival (OS) and progression-free survival (PFS) outcome in patients with pancreatic adenocarcinoma.
We conducted a retrospective study of 106 patients (62 men and 44 women) with histologically proven pancreatic adenocarcinoma who underwent initial staging FDG PET/CT before treatment. Peak standardized uptake value (SUV), maximum SUV (SUVmax), metabolic tumor volume, and tumor glycolytic activity of the primary pancreatic tumor were measured. Two segmentation methods were performed to obtain the metabolic tumor volume and tumor glycolytic activity for all tumors: a gradient-based segmentation model (metabolic tumor volume and tumor glycolytic activity by gradient edge detection) and a fixed-threshold model with a threshold of 50% of the lesion's SUVmax and peak SUV. Univariate and multivariate Cox regression models were developed including clinical and imaging parameters for OS and PFS.
Multivariate Cox regression analysis showed a statistically significant association between PFS and age, SUVmax, peak SUV, and tumor glycolytic activity by gradient edge detection. There was a statistically significant difference in PFS for patients with values above and below the median cutoff points for SUVmax (hazard ratio [HR], 1.12; p < 0.01), peak SUV (HR, 1.25; p < 0.02), and tumor glycolytic activity measured by gradient edge detection (HR, 1.00; p < 0.02) of the primary tumor. However, multivariate Cox regression analysis showed a statistically significant association only between tumor glycolytic activity by gradient edge detection and OS (p = 0.04), and there was a statistically significant difference in OS between patients with values above and below the median cutoff point for the tumor glycolytic activity by gradient edge detection of the primary tumor (HR, 1.42; p = 0.05).
Age, SUVmax, peak SUV, and total lesion glycolysis (i.e., tumor glycolytic activity) of the primary tumor are associated with PFS, and tumor glycolytic activity is associated with OS in patients with pancreatic adenocarcinoma.
本研究旨在评估 PET 衍生参数作为预测标志物在胰腺腺癌患者总生存（OS）和无进展生存（PFS）结局的性能。
我们对 106 例经组织学证实的胰腺腺癌患者进行了回顾性研究，这些患者在治疗前均进行了初始分期 FDG PET/CT。测量了原发胰腺肿瘤的最大标准化摄取值（SUV）、最大 SUV（SUVmax）、代谢肿瘤体积和肿瘤糖酵解活性。使用两种分割方法获得所有肿瘤的代谢肿瘤体积和肿瘤糖酵解活性：基于梯度的分割模型（通过梯度边缘检测获得代谢肿瘤体积和肿瘤糖酵解活性）和固定阈值模型，阈值为病变 SUVmax 和最大 SUV 的 50%。使用单变量和多变量 Cox 回归模型，包括 OS 和 PFS 的临床和影像学参数。
多变量 Cox 回归分析显示，PFS 与年龄、SUVmax、最大 SUV 和通过梯度边缘检测的肿瘤糖酵解活性之间存在统计学显著关联。SUVmax（HR，1.12；p<0.01）、最大 SUV（HR，1.25；p<0.02）和通过梯度边缘检测的肿瘤糖酵解活性（HR，1.00；p<0.02）的中位截止值以上和以下的患者之间，PFS 存在统计学显著差异。然而，多变量 Cox 回归分析仅显示肿瘤糖酵解活性通过梯度边缘检测与 OS 之间存在统计学显著关联（p=0.04），并且在原发肿瘤的肿瘤糖酵解活性通过梯度边缘检测的中位数截止值以上和以下的患者之间，OS 存在统计学显著差异（HR，1.42；p=0.05）。
在胰腺腺癌患者中，年龄、SUVmax、最大 SUV 和原发肿瘤的总病变糖酵解（即肿瘤糖酵解活性）与 PFS 相关，而肿瘤糖酵解活性与 OS 相关。
