방사선의학 웹진

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Abstract
Background: 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).

Methods: 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).

Results: 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.

Conclusions: 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.

그림 1: 자가 조혈모세포 이식을 받은 환자에서 R-ISS 병기는 예후를 유의미하게 분류해 주나 FDG PET/CT 이미지 지표들은 그렇지 않음.

그림 2: 자가 조혈모세포 이식을 받지 않은 환자에서 FDG PET/CT 이미지 지표들은 예후를 유의미하게 분류해 주나 R-ISS 병기로는 초기 예후 분류에 한계가 있음.

그림 3: FDG PET/CT 이미지 지표를 반영하여 병기를 새롭게 구성한 결과 자가 조혈모세포 이식을 받지 않은 환자들에서 R-ISS의 한계를 극복할 수 있음.

Affiliations

Hyunjong Lee # 1, Seung Hyup Hyun 1, Young Seok Cho 1, Seung Hwan Moon 1, Joon Young Choi 1, Kihyun Kim 2, Kyung-Han Lee 3
1Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
2Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
3Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. khleenm@naver.com.
#Contributed equally.