From the *Department of Nuclear Medicine, and †Department of Urology, Urological Science Institute, Severance Hospital, and ‡Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Clin Nucl Med. 2017 May;42(5):e235-e241. doi: 10.1097/RLU.0000000000001612.
The aim of this study was to evaluate the prognostic value of pretreatment metabolic tumor volume (MTV) and total lesion glycolysis (TLG) using F-FDG PET/CT in patients with metastatic renal cell carcinoma (RCC) after treatment with anti-vascular endothelial growth factor-targeted agents.
Fifty-six patients with metastatic RCC who underwent F-FDG PET/CT for staging and recurrence evaluation were retrospectively enrolled. SUVmax, MTV, and TLG were measured using F-FDG PET/CT in all patients. The highest SUV in all the metastatic RCC lesions of each patient was defined as SUVmax. Metabolic tumor volume was defined as the total tumor volume greater than 40% of SUVmax. Total lesion glycolysis was calculated as (MTV) · (SUVmean). The prognostic significance of PET/CT parameters and clinical factors for progression-free survival (PFS) and overall survival (OS) were evaluated by univariate and multivariate analyses, along with other clinical factors.
The most common organ for metastases was lung (35 patients). In the univariate analysis, hypercalcemia, time from diagnosis to treatment, SUVmax, MTV, and TLG were significant prognostic factors affecting PFS (P < 0.05), and Karnofsky score, hypercalcemia, time from diagnosis to treatment, SUVmax, MTV, and TLG were significant prognostic factors affecting OS (P < 0.05). In the multivariate analysis, hypercalcemia, MTV, and TLG were independent prognostic factors affecting PFS (P < 0.05), and hypercalcemia, time from diagnosis to treatment, MTV, and TLG were independent prognostic factors affecting OS (P < 0.05). In subgroup analyses, the high MTV or TLG groups showed poor prognosis for PFS and OS in patients with intermediate or poor risk.
Metabolic tumor volume and TLG are independent prognostic factors for predicting PFS and OS in patients with metastatic RCC. Furthermore, MTV and TLG could provide additional prognostic information in patients with clinically high-risk metastatic RCC treated with anti-vascular endothelial growth factor-targeted therapies.
本研究旨在评估使用 F-FDG PET/CT 检测预处理代谢肿瘤体积（MTV）和总病变糖酵解（TLG）在接受抗血管内皮生长因子靶向药物治疗的转移性肾细胞癌（RCC）患者中的预后价值。
回顾性纳入 56 例接受 F-FDG PET/CT 分期和复发评估的转移性 RCC 患者。所有患者均使用 F-FDG PET/CT 测量 SUVmax、MTV 和 TLG。每位患者所有转移性 RCC 病变中 SUV 的最大值定义为 SUVmax。代谢肿瘤体积定义为 SUVmax 大于 40%的肿瘤总体积。总病变糖酵解计算为（MTV）·（SUVmean）。通过单变量和多变量分析以及其他临床因素评估 PET/CT 参数和临床因素对无进展生存期（PFS）和总生存期（OS）的预后意义。
最常见的转移器官是肺（35 例）。在单变量分析中，高钙血症、诊断至治疗时间、SUVmax、MTV 和 TLG 是影响 PFS 的显著预后因素（P<0.05），卡氏评分、高钙血症、诊断至治疗时间、SUVmax、MTV 和 TLG 是影响 OS 的显著预后因素（P<0.05）。在多变量分析中，高钙血症、MTV 和 TLG 是影响 PFS 的独立预后因素（P<0.05），高钙血症、诊断至治疗时间、MTV 和 TLG 是影响 OS 的独立预后因素（P<0.05）。在亚组分析中，MTV 或 TLG 较高的患者在接受抗血管内皮生长因子靶向治疗的中危或高危转移性 RCC 患者中 PFS 和 OS 预后较差。
代谢肿瘤体积和 TLG 是预测转移性 RCC 患者 PFS 和 OS 的独立预后因素。此外，MTV 和 TLG 可为接受抗血管内皮生长因子靶向治疗的临床高危转移性 RCC 患者提供额外的预后信息。
