Şahin LAÇİN, Abdurrahman IŞIKDOĞAN, Nadiye AKDENİZ, Mehmet KÜÇÜKÖNER, Muhammet Ali KAPLAN, Zuhat URAKÇI, Oğur KARHAN, Halis YERLİKAYA, Halil KÖMEK

Malign Plevral Mezotelyomada Metabolik PET Parametrelerinin Sağkalım Üzerine Etkisi

Amaç: 18-Florodeoksiglukoz pozitron emisyon bilgisayarlı tomografi (18F-FDG PET-BT) en değerli görüntüleme yöntemlerinden biridir ve metabolik tümör volümü de PET-BT'den elde edilebilecek başka bir parametredir. Bu çalışmada MPM'de metabolik PET-BT parametrelerinin sağkalım üzerine etkisini değerlendirmeyi amaçladık. Yöntemler: Çalışmaya Ocak 2016 – Aralık 2017 tarihleri arasında tedavi öncesi 18F-FDG PET-BT çekimi yapılan 29 hasta dahil edildi. Tüm hastaların metabolik tümör volümü (MTV), total lezyon glikolizi (TLG), standardize tutulum değerleri (SUVmax) ve total lezyon glikolizi/karaciğer SUVmean (TLG/KC SUVmean) değerleri hesaplandı. Ayrıca bu parametrelerin sağkalım üzerine etkileri değerlendirildi. Bulgular: Histolojik alt tip olarak epitelioid (n=24), bifazik (n=3) ve sarkomatoid (n=2) alt gruplardan oluşmaktaydı. Ortanca sağkalım 255 (21 - 903) gün idi. Median MTV değeri 225 cm³ (10-1675), median TLG değeri 1056 g/ml*cm³ (36- 1776), median SUVmax değeri 7.7 (1.5-20) ve median TLG/KC SUVmean değeri 561,2 (14.9-8113.7) idi. MTV için cut off değer olarak 113 alındığında sensitivite %86,4 ve spesifite %85,7 idi. TLG için cut off değer olarak 419.5 alındığında sensitivite %81,8 ve spesifite %85,7 idi. Ayrıca TLG/KC SUVmean için cut off değer olarak 107.4 alındığında sensitivite %95,5 ve spesifite %71,4 idi. Yüksek MTV, TLG ve TLG/KC SUVmean'li hastalarda sağkalım oranları daha kötüydü. Sonuç: Çalışmamızda MTV, TLG ve TLG/karaciğer SUVmean değerlerinin sağkalım ile anlamlı bir şekilde ilişkili olduğunu doğrulamış olduk. Bu PET BT parametreleri MPM'de tedavi yanıtını ve prognozu belirlemede kullanılabilir.

The Effect of Metabolic PET Parameters on Survival Outcome in Malignant Pleural Mesothelioma

Objective: 18-Fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) is one ofthe most valuable imaging types and tumor metabolic volume is another parameter that can be obtained from PET-CT.Our primary objective is to evaluate the effect of PET-CT metabolic parameters on survival in patients with malignantpleural mesothelioma (MPM).Methods: A total of 29 patients with MPM had been evaluated with 18F-FDG PET-CT between January 2016 andDecember 2017. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized uptake values (SUVmax) andTLG/liver SUVmean values were calculated. Also, effects of these parameters on survival rates were evaluated.Results: Histological subtypes of the disease were determined as epithelioid (n=24), biphasic (n=3), sarcomatoid (n=2).Median overall survival was 255 days (21-903). Median MTV was 225 cm³ (10-1879), median TLG was 1056 g/ml*cm³(36-18927), median SUVmax was 7.7 (1.5-20) and TLG/liver SUVmean ratio was 561.2 (14.9-8113.7). Sensitivity andspecificity for MTV 113 cut-off value were 86.4% and 85.7%, respectively. Determined cut-off value for TLG was 419.5,sensitivity and specificity of the value were 81.8% and 85.7%, respectively. Additionally, determined cut-off value forTLG/liver SUVmean ratio was 107.4, the rate of sensitivity and specificity for this value were 95.5% and 71.4%,respectively. The patients with higher MTV, TLG and TLG/liver SUVmean had worse survival rate.Conclusion: We confirmed significant association between MTV, TLG and TLG/liver SUVmean values and patientssurvival. These promising PET derived parameters can be used for evaluating treatment response and prognosis in MPM.

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