Na Ritai, Chen Zhao, Liu Yongshun, Chen Qianrui, Yang Qi, Qiu Yongkang, Wang Tianyao, Song Lele, Wu Sitong, Huang Wenpeng, Sun Xinyao, Xian Shaozhong, Kang Lei
Department of Nuclear Medicine, Peking University First Hospital, No. 8 Xishiku Str., Xicheng District, Beijing, China.
Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
EJNMMI Res. 2025 Feb 19;15(1):11. doi: 10.1186/s13550-025-01206-w.
Sarcomatoid differentiation is an invasive dedifferentiated feature of tumor and associated with poor prognosis in renal cell carcinoma (RCC) patients. This study aimed to evaluate the utility of F-FDG PET/CT in predicting sarcomatoid differentiation in RCC and its potential prognostic value.
This retrospective study assessed newly diagnosed sarcomatoid differentiation renal cell carcinoma (SDRCC) patients who were staged using F-FDG PET/CT. Patients were categorized into high-grade sarcomatoid differentiation RCC (HG-SDRCC), low-grade sarcomatoid differentiation RCC (LG-SDRCC), and non-sarcomatoid differentiation RCC (non-SDRCC). The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were compared. Overall survival (OS) and disease-free survival (DFS) were analyzed. SUVmax, MTV, TLG, and SUVmean values were significantly higher in SDRCC compared to non-SDRCC (P < 0.05). Additionally, SUVmax, TLG, and SUVmean were significantly higher in HG-SDRCC compared to non-HG-SDRCC (P < 0.05). ROC curves revealed that SUVmax and SUVmean were effective for distinguishing HG-SDRCC from non-HG-SDRCC. The log-rank test identified SUVmax > 11, MTV > 95, TLG > 500, SUVmean > 5.2, invasion of peripheral tissue and/or organs, and metastasis as risk factors for SDRCC patients. Multivariate Cox proportional hazards model analyses indicated that TLG > 500 was a risk factor for poor DFS, while SUVmax > 11 and SUVmean > 5.2 were risk factors for poor OS.
F-FDG PET/CT can effectively differentiate HG-SDRCC with more aggressive malignancy. The prognostic model developed in this study demonstrates that metabolic parameters, particularly TLG for DFS and SUVmax/SUVmean for OS, serve as more robust predictors of patient outcomes than the degree of sarcomatoid differentiation.
肉瘤样分化是肿瘤的一种侵袭性去分化特征，与肾细胞癌（RCC）患者的不良预后相关。本研究旨在评估F-FDG PET/CT在预测RCC肉瘤样分化中的应用及其潜在的预后价值。
这项回顾性研究评估了使用F-FDG PET/CT进行分期的新诊断的肉瘤样分化肾细胞癌（SDRCC）患者。患者被分为高级别肉瘤样分化RCC（HG-SDRCC）、低级别肉瘤样分化RCC（LG-SDRCC）和非肉瘤样分化RCC（非SDRCC）。比较了最大标准化摄取值（SUVmax）、平均标准化摄取值（SUVmean）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。分析了总生存期（OS）和无病生存期（DFS）。与非SDRCC相比，SDRCC中的SUVmax、MTV、TLG和SUVmean值显著更高（P < 0.05）。此外，与非HG-SDRCC相比，HG-SDRCC中的SUVmax、TLG和SUVmean显著更高（P < 0.05）。ROC曲线显示，SUVmax和SUVmean可有效区分HG-SDRCC与非HG-SDRCC。对数秩检验确定SUVmax > 11、MTV > 95、TLG > 500、SUVmean > 5.2、外周组织和/或器官侵犯以及转移是SDRCC患者的危险因素。多变量Cox比例风险模型分析表明，TLG > 500是DFS不良的危险因素，而SUVmax > 11和SUVmean > 5.2是OS不良的危险因素。
F-FDG PET/CT可有效区分具有更具侵袭性恶性程度的HG-SDRCC。本研究建立的预后模型表明，代谢参数，特别是用于DFS的TLG和用于OS的SUVmax/SUVmean，比肉瘤样分化程度更能可靠地预测患者预后。
