Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Nucl Med. 2023 May;64(5):791-796. doi: 10.2967/jnumed.122.264795. Epub 2023 Jan 5.
Myocardial flow reserve (MFR), derived from quantitative measurements of myocardial blood flow during PET imaging, provides prognostic information on patients with coronary artery disease (CAD), but it is not known if this also applies to cancer patients with a competing risk for mortality. To determine the prognostic value of MFR in patients with cancer, we designed a retrospective cohort study comprising 221 patients with known or suspected CAD (median age, 71 y; range, 41-92 y) enrolled between June 2009 and January 2011. Most patients were referred for perioperative risk assessment. Patients underwent measurement of myocardial blood flow at rest and during pharmacologic stress, using quantitative Rb PET imaging. They were divided into early-stage versus advanced-stage cancer groups based on cancer histopathology and clinical state and were further stratified by myocardial perfusion summed stress score, summed difference score, and calculated MFR. Overall survival (OS) was assessed using the Kaplan-Meier estimator, and Cox proportional-hazards regression helped identify independent predictors for OS. During a follow-up of 85.6 mo, 120 deaths occurred. MFR, summed difference score, and cancer stage were significantly associated with OS. In the age-adjusted Cox hazard multivariable analysis, MFR and cancer stage remained independent prognostic factors. MFR combined with cancer stage enhanced OS discrimination. The groups had significantly different outcomes ( < 0.001), with 5-y OS of 88% (MFR ≥ 1.97 and early-stage), 53% (MFR < 1.97 and early-stage), 33% (MFR ≥ 1.97 and advanced-stage), and 13% (MFR < 1.97 and advanced-stage). Independent of cancer stage, MFR derived from quantitative PET was prognostic of OS in our cohort of cancer patients with known or suspected CAD. Combining these 2 parameters enhanced discrimination of OS, suggesting that MFR improves risk stratification and may serve as a treatment target to increase survival in cancer patients.
心肌血流储备（MFR）是通过正电子发射断层扫描（PET）成像期间的心肌血流定量测量得出的，可提供冠心病（CAD）患者的预后信息，但尚不清楚其是否也适用于有死亡竞争风险的癌症患者。为了确定 MFR 在癌症患者中的预后价值，我们设计了一项回顾性队列研究，该研究纳入了 221 名已知或疑似 CAD 的患者（中位年龄为 71 岁；范围为 41-92 岁），这些患者于 2009 年 6 月至 2011 年 1 月期间入组。大多数患者因围手术期风险评估而就诊。患者接受了定量 Rb PET 成像检查，以评估静息和药物刺激时的心肌血流。根据癌症组织病理学和临床状态，将患者分为早期和晚期癌症组，并进一步根据心肌灌注总和应激评分、总和差异评分和计算出的 MFR 进行分层。使用 Kaplan-Meier 估计器评估总生存（OS），Cox 比例风险回归有助于确定 OS 的独立预测因素。在 85.6 个月的随访中，有 120 例患者死亡。MFR、总和差异评分和癌症分期与 OS 显著相关。在年龄调整后的 Cox 风险多变量分析中，MFR 和癌症分期仍然是独立的预后因素。MFR 与癌症分期相结合可增强 OS 的区分能力。各组的结局差异有统计学意义（<0.001），5 年 OS 分别为 88%（MFR≥1.97 和早期）、53%（MFR<1.97 和早期）、33%（MFR≥1.97 和晚期）和 13%（MFR<1.97 和晚期）。独立于癌症分期，我们队列中的癌症患者（已知或疑似 CAD）的 MFR 与 OS 相关，且定量 PET 衍生的 MFR 可以预测 OS。将这 2 个参数结合起来可增强 OS 的区分能力，这表明 MFR 可改善风险分层，并可能作为增加癌症患者生存的治疗靶点。
