Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Cancer Imaging. 2023 Oct 27;23(1):104. doi: 10.1186/s40644-023-00625-z.
F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is useful in multiple myeloma (MM) for initial workup and treatment response evaluation. Herein, we evaluated the prognostic value of semi-quantitative FDG parameters for predicting the overall survival (OS) of MM patients with or without autologous stem cell transplantation (ASCT).
Study subjects comprised 227 MM patients who underwent baseline FDG PET/CT. Therein, 123 underwent ASCT while 104 did not. Volumes of interest (VOIs) of bones were drawn on CT images using a threshold of 150 Hounsfield units. FDG parameters of maximum standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and number of focal lesions (FLs) were measured. Kaplan-Meier survival analysis with log-rank tests and Cox proportional hazards regression analyses were performed for overall survival (OS).
In the ASCT cohort, R-ISS stage, MTV, and TLG were associated with survival. In the non-ASCT cohort, however, R-ISS stage was not associated with patient outcomes. In contrast, high SUVmax, SUVmean, MTV, TLG, and FL could predict worse OS (hazard ratio [HR] = 2.569, 2.649, 2.506, 2.839, and 1.988, respectively). Importantly, combining FDG parameters with R-ISS stage provided a new risk classification system that discriminated worse OS in the non-ASCT cohort significantly better than did R-ISS stage alone.
In the non-ASCT cohort, semi-quantitative FDG parameters were significant predictors of worse OS. Furthermore, combining FDG parameters with R-ISS stage may provide a new risk staging system that can better stratify the survival of MM patients without ASCT.
氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）在多发性骨髓瘤（MM）中的应用，有助于进行初始检查和评估治疗反应。在此，我们评估了半定量 FDG 参数在预测有无自体干细胞移植（ASCT）的 MM 患者总生存（OS）方面的预后价值。
本研究纳入了 227 例接受基线 FDG PET/CT 检查的 MM 患者。其中 123 例行 ASCT，104 例未行 ASCT。在 CT 图像上，使用 150 个亨氏单位的阈值在骨骼上画出感兴趣区（VOI）。测量最大标准化摄取值（SUVmax）、平均 SUV（SUVmean）、代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）和病灶数（FLs）的 FDG 参数。使用对数秩检验和 Cox 比例风险回归分析进行 Kaplan-Meier 生存分析以评估总生存（OS）。
在 ASCT 队列中，R-ISS 分期、MTV 和 TLG 与生存相关。然而，在非 ASCT 队列中，R-ISS 分期与患者预后无关。相比之下，高 SUVmax、SUVmean、MTV、TLG 和 FL 可预测更差的 OS（风险比[HR]分别为 2.569、2.649、2.506、2.839 和 1.988）。重要的是，将 FDG 参数与 R-ISS 分期相结合，提供了一个新的风险分类系统，与单独的 R-ISS 分期相比，该系统能更好地区分非 ASCT 队列中的较差 OS。
在非 ASCT 队列中，半定量 FDG 参数是 OS 更差的显著预测因素。此外，将 FDG 参数与 R-ISS 分期相结合可能提供一个新的风险分期系统，可更好地分层无 ASCT 的 MM 患者的生存。
