Can ¹⁸F-FDG PET/CT predict recurrence in patients with cutaneous malignant melanoma?

Summary

The aim of this study was to evaluate the prognostic significance of maximum standardized uptake value (SUVmax) of primary cutaneous malignant melanoma (CMM) lesions by ¹⁸F-FDG positron emission tomography/ computerized tomography (PET/ CT) in terms of recurrence. Patients, methods: 37 CMM patients (17 men, mean age: 61.7 ± 13.6 years) that underwent PET/CT at presentation were enrolled in this study. Recurrence was determined by histological confirmation or by radiological and clinical follow- up for at least 8 months after curative surgery. Clinical variables such as age, sex, clinical stage, and primary lesion location, thickness, and ulceration, and SUVmax values were analyzed with respect to their usefulness for predicting recurrence. Results: SUVmax was found to be significantly higher in patients with ulceration of primary lesion of CMM (p = 0.004) and in patients with a stage ≥ III (p < 0.000). Patients that experience recurrence had a significantly higher mean SUVmax value (4.9 ± 2.9) than patients who did not (2.1 ± 1.5, p = 0.024). ROC analysis showed that a SUVmax cut-off value 2.2 had high sensitivity (88.9%) and specificity (67.9%) for predicting recurrence. Kaplan-Meier analysis identified ulceration of primary lesion (p = 0.034), stage ≥ III (p = 0.019) and SUVmax ≥ 2.2 (p = 0.002) as predictors of recurrence. However, Cox proportional-hazards analysis showed that only SUVmax (p = 0.025, relative risk 11.063) significantly predicted recurrence. Conclusion: Preoperative SUVmax of primary lesion was found to be the most potent predictor of recurrence in CMM patient. Patients with high SUV max of primary lesion should be followed meticulously for recurrence.

Zusammenfassung

Ziel dieser Studie war die Beurteilung der prognostischen Aussagekraft des maximalen standardisierten Aufnahmewertes (SUVmax) in Primärtumoren eines kutanen malignen Melanoms (CMM) mittels ¹⁸F-FDG-Positronenemissionstomographie/ Computertomographie (PET/CT) im Hinblick auf Rezidive. Patienten, Methoden: 37 CMM-Patienten (17 Männer, mittleres Alter: 61,7 ± 13,6 Jahre), bei denen eingangs ein PET/CT durchgeführt worden war, wurden in diese Studie aufgenommen. Ein Rezidiv wurde mittels histologischer Untersuchung oder durch radiologische und klinische Nachkontrollen über mindestens 8 Monate nach kurativer Operation festgestellt. Klinische Variablen wie Alter, Geschlecht, klinisches Stadium, Lokalisation, Dicke und Ulzeration des Primärtumors sowie SUVmax- Werte wurden dahingehend analysiert, wie hilfreich sie für die Rezidivprognose sind. Ergebnisse: SUVmax war signifikant höher bei Patienten mit ulzerierten Primärtumoren eines CMM (p = 0,004) und bei Patienten mit einem Stadium ≥ III (p < 0,000). Patienten mit einem Rezidiv wiesen signifikant höhere mittlere SUVmax-Werte auf (4,9 ± 2,9) als rezidivfreie Patienten (2,1 ± 1,5, p = 0,024). Die ROCAnalyse zeigte für einen Cut-off-Wert von 2,2 des SUVmax eine hohe Sensitivität (88,9%) und Spezifität (67,9%) bei der Prognose eines Rezidivs. In der Kaplan-Meier-Analyse wurden die Ulzeration des Primärtumors (p = 0,034), Stadium ≥ III (p = 0,019) und SUVmax ≥ 2,2 (p = 0,002) als Prädiktoren für ein Rezidiv identifiziert. Die Analyse mittels Cox-proportionalhazard- Modell zeigte jedoch, dass nur der SUVmax (p = 0,025, relatives Risiko 11,063) ein Rezidiv signifikant vorhersagen konnte. Schlussfolgerung: Der präoperative SUVmax des Primärtumors war der stärkste Prädiktor eines Rezidivs bei Patienten mit CMM. Patienten mit hohem SUVmax des Primärtumors sollten im Hinblick auf Rezidive engmaschig nachkontrolliert werden.

Keywords

Cutaneous malignant melanoma - ¹⁸F-FDG PET/CT - predicting recurrence - standardized uptake value

Schlüsselwörter

Kutanes malignes Melanom - ¹⁸F-FDG PET/CT - Rezidivprognose - standardisierter Aufnahmewert

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