ÖZ
Amaç
Bu çalışmanın amacı, geniş bir yelpazede elde edilen tedavi öncesi [18F] florodeoksiglukoz pozitron emisyon tomografi/bilgisayarlı tomografi (18F-FDG PET/CT) metabolik ve volumetrik parametrelerinin rutin klinik değişkenlere eklenmesinin mide kanserinde (GC) genel sağkalım (OS) öngörüsünü iyileştirip iyileştirmediğini değerlendirmektir. İkincil amaçlar; kan ve dalak normalizasyonuna dayalı metabolik indekslerin prognostik değerini incelemek ve PET metrikleri ile HER2 durumu arasındaki ilişkileri araştırmaktır.
Yöntemler
Bu retrospektif kohortta, tedavi öncesi 18F-FDG PET/CT verilerinden standart tutulum değeri (SUV)-temelli ve hacimsel PET metrikleri ile BLR_mean ve SLR_mean hesaplandı. Klinik değişkenler, patolojik özellikler, tedavi ayrıntıları, HER2 durumu ve sağkalım sonuçları kurum kayıtlarından elde edildi. OS, başlangıç tedavisinin tarihine göre hesaplandı. Prognostik performans Cox modelleri, kalibrasyon ölçütleri, zamana bağlı eğri altı alan (AUC) ve karar eğrisi analizi (DCA) kullanılarak değerlendirildi. Artımsal değeri belirlemek için klinik model ile klinik+PET içeren iç içe modeller karşılaştırıldı.
Bulgular
SUV- ve hacim temelli PET metrikleri, genel sağkalım ile değişken ancak yön olarak tutarlı ilişkiler gösterdi. MTV_40 ve TLG_40 daha kötü sonuçlara yönelik eğilim sergiledi; ancak bu etkiler çok değişkenli analizlerde tutarlı şekilde istatistiksel anlamlılığa ulaşmadı. Kan ve dalak normalizasyonlu parametreler (BLR_mean ve SLR_mean) PET-only modelde daha güçlü etkiler gösterse de klinik değişkenlere göre ayarlama sonrası bu etkiler zayıfladı. PET parametrelerinin klinik modele eklenmesi ayırıcılığı mütevazı düzeyde artırdı ve kabul edilebilir düzeyde kalibrasyon sağladı. HER2 pozitif tümörler daha yüksek metabolik aktivite gösterdi; ancak HER2 durumunun PET metriklerinin prognostik etkisini anlamlı düzeyde değiştirdiğine dair etkileşim bulunmadı. Klinik olarak anlamlı karar eşiklerinde (10–40%), klinik+PET modeli klinik modele kıyasla daha yüksek net fayda sağladı.
Sonuç
Özetle, tedavi öncesi 18F-FDG PET/CT'nin mide kanserinde rutin klinik değişkenlere ek olarak ilave prognostik bilgi sağlayabileceği görülmektedir. SUV-temelli, hacimsel ve normalizasyonlu metabolik parametrelerin kullanımı risk sınıflandırmasını mütevazı düzeyde iyileştirmekte ve karar analitiği açısından olumlu bir performans sergilemektedir. Bu bulgular, mide kanseri yönetiminde prognostik değerlendirme çerçevelerine nicel PET metriklerinin dahil edilmesinin göz önünde bulundurulabileceğini desteklemektedir.
Anahtar Kelimeler:
Mide kanseri, pozitron emisyon tomografi bilgisayarlı tomografi, fluorodeoksiglukoz F18, prognoz, sağkalım analizi
Kaynaklar
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