Albano Domenico, Familiari Demetrio, Fornito Maria C, Scalisi Salvatore, Laudicella Riccardo, Galia Massimo, Grassedonio Emanuele, Ruggeri Antonella, Ganduscio Gloria, Messina Marco, Spada Massimiliano, Midiri Massimo, Alongi Pierpaolo
Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.
Nuclear Medicine Department A.R.N.A.S GARIBALDI - Nesima, Via Palermo 636, Catania, Italy.
Curr Radiopharm. 2020;13(1):42-47. doi: 10.2174/1874471012666191009161826.
Several studies on 18F-FDG-PET/CT have investigated the prognostic role of this imaging modality in different tumors after treatment. Nevertheless, its role in restaging patients with recurrent CM still needs to be defined.
The aim of this retrospective multicenter study was to evaluate the clinical and prognostic impact of 18F-FDG-PET/CT on the restaging process of cutaneous melanoma (CM) after surgery in patients with suspected distant recurrent disease or suspected metastatic progression disease.
74 patients surgically treated for CM underwent 18F-FDG-PET/CT for suspected distant recurrent disease or suspected metastatic progression disease. The diagnostic accuracy of visually interpreted 18F-FDG-PET/CT was obtained by considering histology (n=21 patients), other diagnostic imaging modalities performed within 2 months of PET/CT (CT in 52/74 patients and Whole-Body MRI in 18/74 patients) and clinical follow-up (n=74 patients) for at least 24 months containing all the clinical and diagnostic information useful for the PET performance assessment and outcome. Progression-free survival (PFS) and overall survival (OS) were assessed by using the Kaplan- Meier method. The risk of progression (Hazard Ratio-HR) was computed by the Cox regression analysis.
Suspicion of recurrent CM was confirmed in 24/27 patients with a positive 18F-FDG-PET/CT scan. Overall, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG-PET/CT were 82%, 93%, 88%, 89%, and 89%, respectively, with area under the curve being 0.87 (95%IC 0.78-0.97; p<0.05). 18F-FDG-PET/CT findings significantly influenced the therapeutic management in 18 patients (modifying therapy in 10 patients; guiding surgery in 8 patients). After 2 years of follow-up, PFS was significantly longer in patients with a negative vs. a positive 18F-FDG-PET/CT scan (90% vs 46%, p<0.05; Fig. 1). Moreover, a negative scan was associated with a significantly longer OS than a positive one (76% vs 39% after 2 years, p<0.05; Fig. 2). In addition, a positive 18F-FDG-PET/CT scan was associated with an increased risk of disease progression (HR=8.2; p<0,05).
18F-FDG-PET/CT showed a valuable diagnostic performance in patients with suspicion of recurrent CM. This imaging modality might have an important prognostic value in predicting the survival outcomes, assessing the risk of disease progression, and guiding treatment decision making.
多项关于18F-FDG-PET/CT的研究探讨了这种成像方式在不同肿瘤治疗后的预后作用。然而，其在复发性皮肤黑色素瘤（CM）患者再分期中的作用仍有待明确。
这项回顾性多中心研究的目的是评估18F-FDG-PET/CT对疑似远处复发疾病或疑似转移性进展疾病的CM患者术后再分期过程的临床和预后影响。
74例接受CM手术治疗的患者因疑似远处复发疾病或疑似转移性进展疾病接受了18F-FDG-PET/CT检查。通过考虑组织学（n=21例患者）、在PET/CT检查后2个月内进行的其他诊断成像方式（52/74例患者进行了CT检查，18/74例患者进行了全身MRI检查）以及至少24个月的临床随访（n=74例患者）来获得视觉解读的18F-FDG-PET/CT的诊断准确性，临床随访包含了所有对PET性能评估和结果有用的临床和诊断信息。采用Kaplan-Meier方法评估无进展生存期（PFS）和总生存期（OS）。通过Cox回归分析计算进展风险（风险比-HR）。
18F-FDG-PET/CT扫描阳性的24/27例患者中复发性CM的怀疑得到证实。总体而言，18F-FDG-PET/CT的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为82%、93%、88%、89%和89%，曲线下面积为0.87（95%IC 0.78-0.97；p<0.05）。18F-FDG-PET/CT检查结果显著影响了18例患者的治疗管理（10例患者改变了治疗方案；8例患者指导了手术）。随访2年后，18F-FDG-PET/CT扫描阴性的患者PFS显著长于阳性患者（90%对46%，p<0.05；图1）。此外，扫描阴性的患者OS显著长于阳性患者（2年后为76%对39%，p<0.05；图2）。此外，18F-FDG-PET/CT扫描阳性与疾病进展风险增加相关（HR=8.2；p<0.05）。
18F-FDG-PET/CT在疑似复发性CM患者中显示出有价值的诊断性能。这种成像方式在预测生存结果、评估疾病进展风险和指导治疗决策方面可能具有重要的预后价值。
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