Department of Nuclear Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362018, People's Republic of China.
Second Clinical School, Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362018, People's Republic of China.
J Cancer Res Clin Oncol. 2023 Nov;149(16):14535-14547. doi: 10.1007/s00432-023-05246-4. Epub 2023 Aug 12.
We aimed to investigate the predictive value of pre-treatment F-FDG PET/CT multi-metabolic parameters and tumor metabolic heterogeneity for gastric cancer prognosis.
Seventy-one patients with gastric cancer were included. All patients underwent F-FDG PET/CT whole-body scans prior to treatment and had pathologically confirmed gastric adenocarcinomas. Each metabolic parameter, including SUVmax, SUVmean, MTV, and TLG, was collected from the primary lesions of gastric cancer in all patients, and the slope of the linear regression between the MTV corresponding to different SUVmax thresholds (40% × SUVmax, 80% × SUVmax) of the primary lesions was calculated. The absolute value of the slope was regarded as the metabolic heterogeneity of the primary lesions, expressed as the heterogeneity index HI-1, and the coefficient of variance of the SUVmean of the primary lesions was regarded as HI-2. Patient prognosis was assessed by PFS and OS, and a nomogram of the prognostic prediction model was constructed, after which the clinical utility of the model was assessed using DCA.
A total of 71 patients with gastric cancer, including 57 (80.3%) males and 14 (19.7%) females, had a mean age of 61 ± 10 years; disease progression occurred in 27 (38.0%) patients and death occurred in 24 (33.8%) patients. Multivariate Cox regression analysis showed that HI-1 alone was a common independent risk factor for PFS (HR: 1.183; 95% CI: 1.010-1.387, P < 0.05) and OS (HR: 1.214; 95% CI: 1.016-1.450, P < 0.05) in patients with gastric cancer. A nomogram created based on the results of Cox regression analysis increased the net clinical benefit for patients. Considering disease progression as a positive event, patients were divided into low-, intermediate-, and high-risk groups, and Kaplan-Meier survival analysis showed that there were significant differences in PFS among the three groups. When death was considered a positive event and patients were included in the low- and high-risk groups, there were significant differences in OS between the two groups.
The heterogeneity index HI-1 of primary gastric cancer lesions is an independent risk factor for patient prognosis. A nomogram of prognostic prediction models constructed for each independent factor can increase the net clinical benefit and stratify the risk level of patients, providing a reference for guiding individualized patient treatment.
本研究旨在探讨治疗前 F-FDG PET/CT 多代谢参数和肿瘤代谢异质性对胃癌预后的预测价值。
本研究共纳入 71 例胃癌患者。所有患者在治疗前均接受 F-FDG PET/CT 全身扫描，并经病理证实为胃腺癌。从所有患者的胃癌原发灶中采集每个代谢参数，包括 SUVmax、SUVmean、MTV 和 TLG，并计算原发灶 MTV 与不同 SUVmax 阈值（40%×SUVmax、80%×SUVmax）之间的线性回归斜率。将原发灶 SUVmean 的斜率绝对值视为原发灶的代谢异质性，用异质性指数 HI-1 表示，将原发灶 SUVmean 的方差系数视为 HI-2。通过 PFS 和 OS 评估患者预后，并构建预后预测模型的列线图，然后使用 DCA 评估模型的临床实用性。
本研究共纳入 71 例胃癌患者，其中男性 57 例（80.3%），女性 14 例（19.7%），平均年龄为 61±10 岁；27 例（38.0%）患者发生疾病进展，24 例（33.8%）患者死亡。多因素 Cox 回归分析显示，HI-1 是胃癌患者 PFS（HR：1.183；95%CI：1.010-1.387，P<0.05）和 OS（HR：1.214；95%CI：1.016-1.450，P<0.05）的共同独立危险因素。基于 Cox 回归分析结果构建的列线图提高了患者的净临床获益。将疾病进展视为阳性事件，将患者分为低危、中危和高危组，Kaplan-Meier 生存分析显示三组间 PFS 差异有统计学意义。当将死亡视为阳性事件，将患者纳入低危和高危组时，两组间 OS 差异有统计学意义。
胃癌原发灶的异质性指数 HI-1 是患者预后的独立危险因素。为每个独立因素构建的预后预测模型列线图可以提高净临床获益并分层患者的风险水平，为指导个体化患者治疗提供参考。
