Department of Nuclear Medicine, Medical Faculty, Selcuk University, Konya, Turkey.
Department of Nuclear Medicine, Medical Faculty, Selcuk University, Konya, Turkey.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2024 Nov-Dec;43(6):500046. doi: 10.1016/j.remnie.2024.500046. Epub 2024 Aug 12.
This study investigates the relationship between F-fluorodeoxyglucose ([F]FDG) positron emission tomography/computed tomography (PET/CT) metabolic parameters, clinicopathological characteristics, and sarcopenia in patients with pancreatic ductal adenocarcinoma (PDAC) and evaluates their prognostic roles.
The primary tumor's maximum standard uptake (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) values, as well as clinicopathological factors, were evaluated retrospectively. Computed tomography (CT) was used to assess the skeletal muscle index (SMI). Sarcopenia was defined based on SMI calculated at the third lumbar vertebra (L3). SMI cut-off values for sarcopenia were accepted as 44.77 cm/m for men and 32.50 cm/m for women. The primary endpoint was the overall survival (OS). OS data were analyzed by the Kaplan-Meier method and compared using the log-rank test. To identify predictive factors for sarcopenia, multivariable logistic regression was used following univariable logistic regression. Cox proportional hazards regression analyses were used to find predictors of OS.
Of the 86 patients included in the study, 37 (43%) were diagnosed with sarcopenia. Compared with non-sarcopenic patients, sarcopenia was observed in older patients (P=0,028) and patients with lower body mass index (BMI) (p=0,001). Age and BMI independently predicted sarcopenia. Univariate analysis identified sarcopenia, advanced stage, and higher primary tumor TLG as significant predictors of overall survival. Multivariate Cox regression analysis revealed that the advanced tumor stage (p=0.017) and higher TLG (p=0,042) independently predicted OS. The median OS was 9.4 months in non-sarcopenic patients and 5.0 months in sarcopenic patients (p=0,021).
In this study cohort, advanced-stage disease and higher primary tumor TLG were identified as independent predictors of OS in patients with PDAC. Additionally, we emphasize the importance of incorporating [F]FDG PET/CT-derived sarcopenia assessments into the prognostic evaluation and clinical management of PDAC patients. While sarcopenia was associated with shorter OS in univariate analysis, it was not an independent predictor in multivariate analysis.
本研究旨在探讨氟代脱氧葡萄糖（[F]FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）代谢参数、临床病理特征与胰腺导管腺癌（PDAC）患者肌肉减少症之间的关系，并评估其预后作用。
回顾性评估原发肿瘤最大标准摄取值（SUVmax）、代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）值以及临床病理因素。采用计算机断层扫描（CT）评估骨骼肌指数（SMI）。基于第 3 腰椎（L3）处计算的 SMI 定义肌肉减少症。男性肌肉减少症的 SMI 截断值为 44.77cm/m，女性为 32.50cm/m。主要终点为总生存期（OS）。采用 Kaplan-Meier 法进行 OS 数据分析，并采用对数秩检验进行比较。采用单变量逻辑回归后多变量逻辑回归确定肌肉减少症的预测因素。采用 Cox 比例风险回归分析确定 OS 的预测因素。
在纳入的 86 例患者中，37 例（43%）被诊断为肌肉减少症。与非肌肉减少症患者相比，肌肉减少症患者年龄较大（P=0.028），体质指数（BMI）较低（P=0.001）。年龄和 BMI 独立预测肌肉减少症。单变量分析确定肌肉减少症、晚期疾病和较高的原发肿瘤 TLG 是总生存的显著预测因素。多变量 Cox 回归分析显示，晚期肿瘤分期（p=0.017）和较高的 TLG（p=0.042）独立预测 OS。非肌肉减少症患者的中位 OS 为 9.4 个月，肌肉减少症患者为 5.0 个月（p=0.021）。
在本研究队列中，晚期疾病和较高的原发肿瘤 TLG 被确定为 PDAC 患者 OS 的独立预测因素。此外，我们强调将 [F]FDG PET/CT 衍生的肌肉减少症评估纳入 PDAC 患者的预后评估和临床管理的重要性。虽然肌肉减少症在单变量分析中与较短的 OS 相关，但在多变量分析中并非独立预测因素。
