Utilidad de la PET/TC con [18F]FDG más allá de la estadificación: importancia pronóstica de la sarcopenia y del metabolismo del tejido adiposo en el carcinoma esofágico

IF 1.6 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Revista Espanola De Medicina Nuclear E Imagen Molecular Pub Date : 2025-07-01 DOI:10.1016/j.remn.2024.500090

M.N. Acar Tayyar , M. Öner Tamam , G. Buğrahan Babacan , M. Can Şahin , H. Özçevik , N. Gürdal , K. Atakır

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引用次数: 0

Abstract

Aim

This study aimed to investigate the relationship between PET and CT parameters and sarcopenia, adipose tissue, and tumor metabolism in esophageal carcinoma (EC) and its impact on survival in EC.

Method

Our study included 122 EC patients who underwent PET/CT for staging. Muscle and adipose tissue characteristics were evaluated, including lumbar (L3) and cervical (C3) muscle areas, psoas major (PM) and sternocleidomastoid muscle (SCM) parameters, and PET parameters for visceral and subcutaneous adipose tissue (SAT). Sarcopenia was determined using CT images, with a threshold for muscle tissue at the L3 vertebral level, and its impact on overall survival (OS) was investigated.

Results

Sarcopenia was detected in 48 patients. SULmax in the primary tumor (PT) was significantly higher in sarcopenic patients (SP). The frequency of distant metastasis was higher in SP and OS was significantly lower. In the locally advanced stage, sarcopenia status decreased survival. L3, PM, C3, and SCM muscle areas were highly correlated. Subcutaneous adipose tissue SUVmax was significantly increased in SP and those with distant metastasis. Univariate analysis identified PT SULmax, PT SUVmean, PT TLG, lymph node and distant metastasis, SAT SUVmax, and sarcopenia as poor prognostic factors, while multivariate analysis confirmed BMI, distant metastasis, PT SUVmean, PT TLG as independent predictors of OS.

Conclusion

This study demonstrated that sarcopenia, linked to reduced survival, correlates with primary tumor SULmax, distant metastasis, and subcutaneous tissue PET parameters, exerting a notable impact on survival, particularly in locally advanced stages. Attenuation-corrected CT can be used instead of diagnostic CT, and sarcopenia can be diagnosed using not only L3 but also C3 slices.

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PET/ CT与[18F]FDG的应用超越了确定阶段：在食管癌中减少结节和脂肪组织代谢的预后重要性

目的探讨PET、CT参数与食管癌（EC）肌肉减少症、脂肪组织及肿瘤代谢的关系及其对生存的影响。方法122例EC患者行PET/CT分期。评估肌肉和脂肪组织特征，包括腰椎（L3）和颈椎（C3）肌肉区域、腰肌（PM）和胸锁乳突肌（SCM）参数，以及内脏和皮下脂肪组织（SAT）的PET参数。使用CT图像确定肌肉减少症，并在L3椎体水平设置肌肉组织阈值，并研究其对总生存期（OS）的影响。结果48例患者出现肌肉减少症。原发性肿瘤患者（PT）的SULmax明显高于肌肉减少症患者（SP）。SP的远处转移频率较高，OS的远处转移频率明显较低。在局部晚期，肌少症状态降低了生存率。L3、PM、C3和SCM肌区高度相关。皮下脂肪组织SUVmax在SP和远处转移患者中显著增加。单因素分析发现PT SULmax、PT SUVmean、PT TLG、淋巴结和远处转移、SAT SUVmax和肌肉减少症是不良预后因素，多因素分析证实BMI、远处转移、PT SUVmean、PT TLG是OS的独立预测因素。本研究表明，肌肉减少症与生存率降低有关，与原发肿瘤SULmax、远处转移和皮下组织PET参数相关，对生存率有显著影响，特别是在局部晚期。可以使用衰减校正CT代替诊断性CT，不仅可以使用L3片，还可以使用C3片诊断肌肉减少症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista Espanola De Medicina Nuclear E Imagen Molecular RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

1.10

自引率

16.70%

发文量

审稿时长

24 days

期刊介绍： The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles.