这项研究调查了18F-氟代脱氧葡萄糖([18F]FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)代谢参数之间的关系,临床病理特征,胰腺导管腺癌(PDAC)患者的肌肉减少症,并评估其预后作用。
方法:原发肿瘤的最大标准摄取(SUVmax),代谢性肿瘤体积(MTV),和总病变糖酵解(TLG)值,以及临床病理因素,进行回顾性评估。计算机断层扫描(CT)用于评估骨骼肌指数(SMI)。基于在第三腰椎(L3)处计算的SMI来定义肌肉减少症。男性的SMI临界值为44.77cm2/m2,女性为32.50cm2/m2。主要终点是总生存期(OS)。OS数据采用Kaplan-Meier法分析,并采用对数秩检验进行比较。为了确定肌肉减少症的预测因素,单变量逻辑回归后使用多变量逻辑回归。Cox比例风险回归分析用于寻找OS的预测因子。
结果:在纳入研究的86名患者中,37例(43%)被诊断为肌肉减少症。与非肌少症患者相比,老年患者(P=0,028)和体重指数(BMI)较低的患者(p=0,001)观察到肌肉减少症。年龄和BMI可独立预测肌肉减少症。单因素分析确定肌少症,高级阶段,和较高的原发性肿瘤TLG是总生存率的重要预测因子。多因素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。非肌少症患者的中位OS为9.4个月,肌少症患者的中位OS为5.0个月(p=0.021)。
结论:在本研究队列中,在PDAC患者中,晚期疾病和高原发灶TLG被确定为OS的独立预测因子.此外,我们强调将[18F]FDGPET/CT衍生的肌少症评估纳入PDAC患者的预后评估和临床治疗的重要性.虽然在单因素分析中,肌肉减少症与较短的OS相关,在多变量分析中,它不是独立预测因子.
This study investigates the relationship between 18F-
fluorodeoxyglucose ([18F]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.
METHODS: 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 cm2/m2 for men and 32.50 cm2/m2 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.
RESULTS: 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).
CONCLUSIONS: 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 [18F]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.