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Objective:To investigate the prognostic value of metabolic parameters measured by 18F-FDG PET/CT in patients with primary advanced cutaneous malignant melanoma (CMM). Methods:A retrospective analysis was comprised of 42 patients with advanced CMM (15 males and 27 females; median age: 60.0 years) from Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between June 2014 and December 2019. All patients were initially diagnosed by pathology, and underwent 18F-FDG PET/CT imaging. 18F-FDG PET/CT parameters including SUV max, SUV mean, total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) of metastatic lesions were measured. ROC curve analysis was performed to obtain the optimal cut-off values of those metabolic parameters for predicting progression-free survival (PFS) and over-all survival (OS). Patients were divided into different groups based on their metabolic parameters (≥cut-off values or <cut-off values), and Kaplan-Meier survival curve and log-rank test were used to analyze the OS/PFS differences between 2 groups. The independent prognostic risk factors of PFS and OS were screened by univariate analysis and Cox proportional risk model. Results:The median follow-up time of 42 patients with advanced CMM was 26.3 months, with 32 patients suffered from disease progression and 21 patients died, and the median survival was 33.1 months. The optimal cut-off values for PFS/OS were 4.63/4.77 for SUV max, 3.31/3.31 for SUV mean, 8.22 cm 3/22.32 cm 3 for TMTV, and 18.22 g/51.37 g for TLG, respectively. Kaplan-Meier analysis and log-rank test showed that patients with SUV max ≥4.63 or SUV mean ≥3.31 suffered from poorer PFS ( χ2 values: 7.12, 5.42, P values: 0.008, 0.020), meanwhile, patients with SUV max ≥4.77 or TMTV≥22.32 cm 3 or TLG≥51.37 g suffered from poorer OS ( χ2 value: 4.73, 5.60, 6.31, P values: 0.030, 0.018, 0.012). Multivariate analysis demonstrated that SUV max was significant predictor for both PFS (hazard risk ( HR)=3.03(95% CI: 1.23-7.45), P=0.016) and OS ( HR=3.62(95% CI: 1.19-11.00), P=0.023), while TMTV and TLG were significant predictors for OS ( HR: 2.87(95% CI: 1.20-6.87), 3.34(95% CI: 1.39-8.05); P values: 0.018, 0.007). Conclusions:Baseline 18F-FDG PET/CT metabolic parameters have certain value in prediction of prognosis in patients with advanced CMM. SUV max of metastatic lesions is an independent prognostic risk factor for both PFS and OS, and TMTV and TLG are independent prognostic risk factors for OS in patients with advanced CMM.
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Objective:To assess the prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in patients with metastatic malignant melanoma treated with anti-programmed cell death-1 (PD1) immunotherapy. Methods:A retrospective analysis of 29 patients (15 males, 14 females, age (59.1±13.0) years) with pathologically diagnosed metastatic malignant melanoma in Nanjing Drum Tower Hospital between June 2017 and October 2020 was conducted. Anti-PD1 immunotherapy were performed in all patients after 18F-FDG PET/CT imaging. 18F-FDG PET/CT parameters including SUV max, bone marrow-to-liver SUV max ratio (BLR), spleen-to-liver SUV max ratio (SLR) were obtained. Total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) of primary lesions were measured automatically using the thresholds of 40%SUV max. The median value of each PET parameter was regarded as the threshold value and was used to divide patients into 2 groups (≥ and < the median value, respectively). Kaplan-Meier survival curve and Cox proportional risk model were used to analyze the overall survival (OS) differences between groups. Results:The median follow-up time was 15.0 months and 13 patients died. The median OS was 26.0(95% CI: 20.4-31.6) months. The median SUV max, TMTV, TLG, BLR and SLR were 6.2, 8.2 cm 3, 38.6 g, 0.82 and 0.84 respectively. Kaplan-Meier method and log-rank test showed that differences of OS between SUV max≥6.2 and <6.2 groups, TLG≥38.6 g and <38.6 g groups, BLR≥0.82 and <0.82 groups, SLR≥0.84 and <0.84 groups were not significant ( χ2 values: 0.01-0.35, P values: 0.061-0.929), while patients with TMTV≥8.2 cm 3 suffered from poorer OS compared with those with TMTV<8.2 cm 3 ( χ2=5.90, P=0.015). Cox multivariate analysis showed that TMTV (hazard risk ( HR)=6.347, 95% CI: 1.039-38.789) was a significant predictor of OS ( P=0.045). Conclusion:18F-FDG PET/CT parameter TMTV is the independent predictive factor of OS in metastatic melanoma treated with anti-PD1 immunotherapy.
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Objective:To assess the prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in patients with primary melanoma. Methods:A retrospective analysis comprised of 35 patients (21 males, 14 females, age: 35-85 years; from January 2014 to August 2019; Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School) who were newly-diagnosed primary melanoma with preoperative 18F-FDG PET/CT was conducted. 18F-FDG PET/CT metabolic parameters including SUV max, SUV mean, peak of SUV (SUV peak) were obtained. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary focus were measured automatically using the threshold of 40%SUV max. The optimal thresholds of PET parameters were obtained by using ROC curve analysis. The associations between melanoma-specific survival (MSS), progression-free survival (PFS) and PET/CT metabolic parameters were assessed using Kaplan-Meier method and Cox proportional hazards model. Results:The median follow-up was 15.4 months, and 20 patients showed disease progression and 7 died. The cut-off values for SUV max, SUV mean, SUV peak, MTV and TLG were 3.95, 2.45, 2.65, 3.60 cm 3 and 14.85 g, respectively (AUCs: 0.742, 0.790, 0.728, 0.655, 0.693; P values: 0.016, 0.004, 0.022, 0.121, 0.053). Kaplan-Meier method and log-rank test showed that SUV max, SUV mean, SUV peak, MTV and TLG were predictors of PFS ( χ2 values: 4.06-8.35, all P<0.05). Multivariate analysis showed that MTV (hazard ratio ( HR)=3.09, 95% CI: 1.08-8.86, P=0.036) and TLG ( HR=3.36, 95% CI: 1.11-10.14, P=0.031) were significant predictors of PFS but not for MSS ( HR=5.14, P=0.080). Conclusions:SUV max, SUV mean and SUV peak of primary focus may help for predicting PFS of patients with primary melanoma. MTV and TLG of primary focus may be the best to predict PFS of primary melanoma.
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Objective: To study the relationships between the expressions of E-cadherin and ki-67 in the tissues of heatocellular carcinoma(HCC)and the prognosis of HCC patients after hepatectomy as well as their clinical pathology. Methods: We examine the expressions of E-cadherin and ki-67 in 255 HCC tissues by tissue microarray and PV-6000 two-step method of immunohistochemistry and analyze the correlations between their expressions and clinical pathological data, 1-year recurrent rate and overall survival time after hepatectomy. Results: The expression of E-cadherin correlated with the tumor size and the 1-year recurrent rate of positive group was higher than that of the negative group. The expression of ki-67 correlated with vascular invasion and differentiation of the tumor, the positive group showed a higher 1-year recurrent rate and a shorter overall survival time. Multivariate Cox regression analysis indicated that the expression of ki-67 was an independent risky factor. Conclusions: The negative expression of E-cadherin and the positive expression of ki-67 predict a higher recurrent rate of early stage. The expression of ki-67 is an independent risky factor which can be used to evaluate the prognosis of patients with HCC after hepatectomy.