Multipl miyelomda metabolik tümör hacmi ve total lezyon glikolizinin prognostik etkisi

Öz

Amaç: 18F-2′-deoksi-2′-florodeoksiglukoz pozitron emisyon tomografisi (18F-FDG PET), multipl miyelomun (MM) tanısında kritik bir görüntüleme aracıdır ve tümör yükü ile hastalığın proliferatif kapasitesi hakkında kapsamlı bilgiler sunar. Bu çalışmada, tedavi öncesi 18F-FDG PET parametrelerinin MM hastalarında sağkalımı öngörmedeki rolü incelendi. Gereç ve yöntem: Ekim 2019 ile Mart 2024 tarihleri arasında, tedavi öncesi 18F-FDG PET incelemesi yapılan 41 MM hastası retrospektif olarak analiz edildi. Hastaların klinik özellikleri, tedavi yanıtları ve sağkalım verileri değerlendirildi. Bulgular: Medyan progresyonsuz sağkalım (PFS) 28,51±3,82 ay, medyan genel sağkalım (OS) ise 34,57±3,9 ay olarak hesaplandı. Ekstramedüller hastalık (EMD) varlığı, yüksek metabolik tümör hacmi (MTV) ve artmış total lezyon glikolizi (TLG), progresyon riskini anlamlı şekilde arttırken (p<0,05) PFS için olumsuz prognostik faktörler olarak belirlendi. Benzer şekilde, yüksek MTV, maksimum standart uptake değeri (SUVmax), ortalama standart uptake değeri (SUVmean) ve TLG ise mortalite riskini artırarak OS için olumsuz prognostik faktörler olarak saptandı (p<0,05). Çok değişkenli analizde, MTV ve TLG OS için bağımsız prognostik faktörler olarak doğrulandı ve MM’de prognostik önem taşıdıkları gösterildi. Sonuç: MTV ve TLG, multipl miyelomda önemli prognostik belirteçler olarak saptanmıştır. Bu parametreler tümörün hacimsel ve metabolik yükünü yansıttığından, Uluslararası Evreleme Sistemi’ne (ISS) entegre edilmeleri risk sınıflamasını ve prognostik değerlendirmeyi iyileştirebilir.

Anahtar Kelimeler

• Multipl miyelom
• prognoz
• ekstramedüller hastalık
• metabolic tümör hacmi
• total lezyon glikolizi

Destekleyen Kurum

Tüm yazarlar, sunulan çalışma ile doğrudan veya dolaylı olarak ilgili hiçbir mali veya mali olmayan çıkarları olmadığını beyan ederler. Bu araştırma, kamu, ticari veya kar amacı gütmeyen sektörlerdeki fon kuruluşlarından herhangi bir özel hibe almamıştır.

Etik Beyan

Bu çalışma Helsinki Bildirgesi ilkeleri doğrultusunda gerçekleştirilmiştir. Pamukkale Üniversitesi Etik Kurulu tarafından onaylanmış ve her hastadan veya hastanın birinci derece yakınlarından yazılı bilgilendirilmiş onam alınmıştır.

Teşekkür

Yazarlar, hastaların raporlanmasında ve verilerin toplanmasında emeği geçen herkese teşekkürlerini sunar.

Prognostic impact of metabolic tumor volume and total lesion glycolysis in multiple myeloma

Öz

Purpose: 18F-2′-deoxy-2′-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is a critical imaging tool for diagnosing multiple myeloma (MM), providing comprehensive insights into tumor burden and disease proliferation capacity. We evaluated the value of pretreatment 18F-FDG PET parameters in forecasting survival in patients with MM. Materials and methods: Between October 2019 and March 2024, a cohort of 41 patients with MM who received pretreatment 18F-FDG PET scans was retrospectively analyzed. Clinical characteristics, treatment response, and survival data were systematically evaluated. Results: The median progression-free survival (PFS) was 28.51±3.82 months, while the median overall survival (OS) was calculated as 34.57±3.9 months. The presence of extramedullary disease (EMD), high metabolic tumor volume (MTV), and elevated total lesion glycolysis (TLG) were significantly associated with an increased risk of progression (p<0.05), establishing them as poor prognostic factors for PFS. Similarly, high MTV, maximum standardized uptake value (SUVmax, SUVmean, and TLG were strongly correlated with an increased mortality risk (p<0.05) and were identified as adverse prognostic factors for overall survival. In multivariate analysis, MTV and TLG were confirmed to be independent prognostic factors for OS, supporting their role in predicting prognosis in MM. Conclusion: MTV and TLG were found to have important prognostic implications in multiple myeloma. Since these parameters reflect volumetric and metabolic tumor burden, their integration into the International Staging System (ISS) may improve risk stratification and prognosis assessment.

Anahtar Kelimeler

• Multiple myeloma
• prognosis
• extramedullary disease
• metabolic tumor volume
• total lesion glycolysis

Destekleyen Kurum

All authors declare that they have no relevant financial or non-financial interests, whether directly or indirectly related to the submitted work, to disclose. This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Etik Beyan

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Pamukkale University and written informed consents were obtained from each patient or first-degree relatives of the patient.

Teşekkür

The authors would like to express their gratitude to all those involved in reporting patients and collecting data.

Kaynakça

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