Hinzpeter Ricarda, Mirshahvalad Seyed Ali, Kulanthaivelu Roshini, Murad Vanessa, Ortega Claudia, Metser Ur, Liu Zhihui Amy, Elimova Elena, Wong Rebecca K S, Yeung Jonathan, Jang Raymond W, Veit-Haibach Patrick
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
Diagnostics (Basel). 2023 Feb 22;13(5):838. doi: 10.3390/diagnostics13050838.
We investigated the prognostic value of sarcopenia measurements and metabolic parameters of primary tumors derived from F-FDG-PET/CT among patients with primary, metastatic esophageal and gastroesophageal cancer. A total of 128 patients (26 females; 102 males; mean age 63.5 ± 11.7 years; age range: 29-91 years) with advanced metastatic gastroesophageal cancer who underwent F-FDG-PET/CT as part of their initial staging between November 2008 and December 2019 were included. Mean and maximum standardized uptake value (SUV) and SUV normalized by lean body mass (SUL) were measured. Skeletal muscle index (SMI) was measured at the level of L3 on the CT component of the F-FDG-PET/CT. Sarcopenia was defined as SMI < 34.4 cm/m in women and <45.4 cm/m in men. A total of 60/128 patients (47%) had sarcopenia on baseline F-FDG-PET/CT. Mean SMI in patients with sarcopenia was 29.7 cm/m in females and 37.5 cm/m in males. In a univariable analysis, ECOG (<0.001), bone metastases ( = 0.028), SMI ( = 0.0075) and dichotomized sarcopenia score ( = 0.033) were significant prognostic factors for overall survival (OS) and progression-free survival (PFS). Age was a poor prognostic factor for OS ( = 0.017). Standard metabolic parameters were not statistically significant in the univariable analysis and thus were not evaluated further. In a multivariable analysis, ECOG ( < 0.001) and bone metastases ( = 0.019) remained significant poor prognostic factors for OS and PFS. The final model demonstrated improved OS and PFS prognostication when combining clinical parameters with imaging-derived sarcopenia measurements but not metabolic tumor parameters. In summary, the combination of clinical parameters and sarcopenia status, but not standard metabolic values from F-FDG-PET/CT, may improve survival prognostication in patients with advanced, metastatic gastroesophageal cancer.
我们研究了原发性、转移性食管癌和胃食管癌患者中，基于F-FDG-PET/CT测量的原发性肿瘤的肌肉减少症指标和代谢参数的预后价值。纳入了2008年11月至2019年12月期间，共128例（26例女性；102例男性；平均年龄63.5±11.7岁；年龄范围：29-91岁）晚期转移性胃食管癌患者，他们接受了F-FDG-PET/CT检查作为初始分期的一部分。测量了平均和最大标准化摄取值（SUV）以及经去脂体重标准化的SUV（SUL）。在F-FDG-PET/CT的CT部分，于L3水平测量骨骼肌指数（SMI）。肌肉减少症定义为女性SMI<34.4 cm/m，男性<45.4 cm/m。在基线F-FDG-PET/CT检查中，共有60/128例患者（47%）存在肌肉减少症。肌肉减少症患者的平均SMI，女性为29.7 cm/m，男性为37.5 cm/m。在单变量分析中，东部肿瘤协作组（ECOG）评分（<0.001）、骨转移（=0.028）、SMI（=0.0075）和二分法肌肉减少症评分（=0.033）是总生存期（OS）和无进展生存期（PFS）的显著预后因素。年龄是OS的不良预后因素（=0.017）。在单变量分析中，标准代谢参数无统计学意义，因此未进一步评估。在多变量分析中，ECOG评分（<0.001）和骨转移（=0.019）仍然是OS和PFS的显著不良预后因素。最终模型显示，将临床参数与影像衍生的肌肉减少症测量结果相结合，而非代谢肿瘤参数，可改善OS和PFS的预后预测。总之，临床参数与肌肉减少症状态相结合，而非F-FDG-PET/CT的标准代谢值，可能改善晚期转移性胃食管癌患者的生存预后。
