Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
Cancer Imaging. 2020 Jul 6;20(1):44. doi: 10.1186/s40644-020-00322-1.
To investigate the association of tumor volumetric parameters in melanoma patients undergoing F-FDG-PET/CT with serologic tumor markers and inflammatory markers and the role as imaging predictors for overall survival.
A patient cohort with advanced melanoma undergoing F-FDG-PET/CT for planning metastasectomy between 04/2013 and 01/2015 was retrospectively included. The volumetric PET parameters whole-body MTV and whole-body TLG as well as the standard uptake value (SUV) peak were quantified using 50%-isocontour volumes of interests (VOIs) and then correlated with the serologic parameters lactate dehydrogenase (LDH), S-100 protein, c-reactive protein (CRP) and alkaline phosphatase (AP). PET parameters were dichotomized by their respective medians and correlated with overall survival (OS) after PET/CT. OS was compared between patients with or without metastases and increased or not-increased serologic parameters.
One hundred seven patients (52 female; 65 ± 13.1yr.) were included. LDH was strongly associated with MTV (r = 0.73, p < 0.001) and TLG (r = 0.62, p < 0.001), and moderately associated with SUV (r = 0.55, p < 0.001). S-100 protein showed a moderate association with MTV (r = 0.54, p < 0.001) and TLG (r = 0.48, p < 0.001) and a weak association with SUV (r = 0.42, p < 0.001). A strong association was observed between CRP and MTV (r = 0.66, p < 0.001) and a moderate to weak association between CRP and TLG (r = 0.53, p < 0.001) and CRP and SUV (r = 0.45, p < 0.001). For differentiation between patients with or without metastases, receiver operating characteristic (ROC) analysis revealed a cut-off value of 198 U/l for serum LDH (AUC 0.81, sensitivity 0.80, specificity 0.72). Multivariate analysis for OS revealed that both MTV and TLG were strong independent prognostic factors. TLG, MTV and SUV above patient median were accompanied with significantly reduced estimated OS compared to the PET parameters below patient median (e.g. TLG: 37.1 ± 3.2 months vs. 55.9 ± 2.5 months, p < 0.001). Correspondingly, both elevated serum LDH and S-100 protein were accompanied with significantly reduced OS (36.5 ± 4.9 months and 37.9 ± 4.4 months) compared to normal serum LDH (49.2 ± 2.4 months, p = 0.01) and normal S-100 protein (49.0 ± 2.5 months, p = 0.01).
Tumor volumetric parameters in F-FDG-PET/CT serve as prognostic imaging biomarkers in patients with advanced melanoma which are associated with established serologic tumor markers and inflammatory markers.
研究黑色素瘤患者 F-FDG-PET/CT 中的肿瘤体积参数与血清肿瘤标志物和炎症标志物的相关性，并探讨其作为总生存期的影像学预测因子的作用。
回顾性纳入了 2013 年 4 月至 2015 年 1 月期间因计划行转移灶切除术而接受 F-FDG-PET/CT 的晚期黑色素瘤患者的患者队列。使用 50%等体积感兴趣区（VOI）定量了全身 MTV 和全身 TLG 以及标准摄取值（SUV）峰值等全身 PET 参数，并与血清学参数乳酸脱氢酶（LDH）、S-100 蛋白、C-反应蛋白（CRP）和碱性磷酸酶（AP）进行相关性分析。通过各自中位数将 PET 参数进行二分，并与 PET/CT 后总生存期（OS）相关联。比较 PET 阳性和阴性患者以及血清学参数升高和不升高患者的 OS。
共纳入 107 例患者（52 例女性；65±13.1 岁）。LDH 与 MTV（r=0.73，p<0.001）和 TLG（r=0.62，p<0.001）强烈相关，与 SUV 中度相关（r=0.55，p<0.001）。S-100 蛋白与 MTV（r=0.54，p<0.001）和 TLG（r=0.48，p<0.001）中度相关，与 SUV 弱相关（r=0.42，p<0.001）。CRP 与 MTV（r=0.66，p<0.001）之间存在强烈相关性，与 TLG（r=0.53，p<0.001）和 SUV（r=0.45，p<0.001）之间存在中度至弱相关性。对于区分有或无转移的患者，接受者操作特征（ROC）分析显示血清 LDH 的截断值为 198 U/l（AUC 0.81，灵敏度 0.80，特异性 0.72）。多变量分析显示，MTV 和 TLG 均为独立的强预后因素。与患者中位数以下的 PET 参数相比，MTV 和 TLG 高于患者中位数的患者 OS 估计值明显降低（例如 TLG：37.1±3.2 个月与 55.9±2.5 个月，p<0.001）。相应地，血清 LDH 和 S-100 蛋白升高均与明显降低的 OS 相关（36.5±4.9 个月和 37.9±4.4 个月），与正常血清 LDH（49.2±2.4 个月，p=0.01）和正常 S-100 蛋白（49.0±2.5 个月，p=0.01）相比。
F-FDG-PET/CT 中的肿瘤体积参数可作为晚期黑色素瘤患者的预后影像学生物标志物，与已建立的血清肿瘤标志物和炎症标志物相关。
