Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eur Radiol. 2021 Jan;31(1):152-162. doi: 10.1007/s00330-020-07177-x. Epub 2020 Aug 18.
We performed a systematic review and meta-analysis on the prognostic values of F-FDG PET/CT in patients with newly diagnosed multiple myeloma (MM).
PubMed and Embase were searched until July 10, 2019, for studies that reported the prognostic significance of F-FDG PET in patients with newly diagnosed MM, with overall (OS) and progression-free survival (PFS) included as outcomes. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were meta-analytically pooled using a random-effects model.
Fifteen studies (1670 patients) were included for qualitative synthesis. Among multiple PET parameters, the presence of extramedullary disease (EMD), more than three focal lesions (FLs), and high FDG uptake were widely evaluated and significantly associated with shorter OS and PFS in most of the included studies. Among 11 studies included in quantitative synthesis, the overall HRs of EMD, more than three FLs, and high FDG uptake on PFS were 2.12 (95% CI, 1.52-2.96), 2.38 (95% CI, 1.84-3.07), and 2.02 (95% CI, 1.51-2.68), respectively. The pooled HRs of those three parameters on OS were 2.37 (95% CI, 1.77-3.16), 3.29 (95% CI, 2.38-4.56), and 2.28 (95% CI, 1.67-3.13). No statistical differences were found across parameters for either PFS (p = 0.6822) or OS (p = 0.2147).
Pretreatment F-FDG PET/CT is a significant predictor for disease progression and survival in patients with MM. It may be a useful prognostic biomarker capable of accurate risk stratification and application in clinical decision-making for newly diagnosed MM.
• There remain unmet clinical needs for reliable prognostic biomarkers in patients with newly diagnosed multiple myeloma. • This meta-analysis shows that the presence of extramedullary disease, more than three focal lesions, and high FDG uptake from baseline F-FDG PET are significant prognostic factors. • These imaging biomarkers might help the accurate stratification of patient prognosis which is required for choosing an appropriate therapeutic strategy in clinical practice.
我们对新诊断多发性骨髓瘤（MM）患者的 F-FDG PET/CT 预后价值进行了系统评价和荟萃分析。
检索 PubMed 和 Embase 数据库，以获取截至 2019 年 7 月 10 日发表的报告 F-FDG PET 对新诊断 MM 患者预后意义的研究，将总生存期（OS）和无进展生存期（PFS）作为结局。使用随机效应模型对风险比（HR）及其 95%置信区间（CI）进行荟萃分析。
纳入 15 项研究（1670 例患者）进行定性综合分析。在多种 PET 参数中，骨髓外疾病（EMD）、超过 3 个局灶性病变（FLs）和 FDG 摄取高被广泛评估，并且在大多数纳入的研究中与较短的 OS 和 PFS 显著相关。在纳入的 11 项定量综合研究中，EMD、超过 3 个 FLs 和高 FDG 摄取对 PFS 的总体 HR 分别为 2.12（95%CI，1.52-2.96）、2.38（95%CI，1.84-3.07）和 2.02（95%CI，1.51-2.68）。这三个参数对 OS 的合并 HR 分别为 2.37（95%CI，1.77-3.16）、3.29（95%CI，2.38-4.56）和 2.28（95%CI，1.67-3.13）。对于 PFS（p=0.6822）或 OS（p=0.2147），各个参数之间没有统计学差异。
治疗前 F-FDG PET/CT 是 MM 患者疾病进展和生存的重要预测指标。它可能是一种有用的预后生物标志物，能够对新诊断 MM 进行准确的风险分层并应用于临床决策。
新诊断多发性骨髓瘤患者仍存在对可靠预后生物标志物的临床需求。
这项荟萃分析表明，基线 F-FDG PET 中存在骨髓外疾病、超过 3 个局灶性病变和 FDG 摄取高是显著的预后因素。
这些影像学生物标志物可能有助于准确分层患者的预后，这是在临床实践中选择适当治疗策略所必需的。
