Abstract
Malignant melanoma is one of the more aggressive cancers in the skin, with an increasing incidence every year. Melanoma has a better prognosis if diagnosed early and survival tends to decrease once the disease has metastasized. Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) has been used extensively over the past two decades in staging and assessing responses to therapy in patients with melanoma. Metabolic PET parameters have been demonstrated to be independent prognostic factors for progression-free survival (PFS) and overall survival (OS) in different malignancies, melanoma included. In our study, we evaluated the metabolic parameters of 18F-FDG PET/CT (flourodeoxyglucose positron emission tomography/computed tomography) in predicting the overall survival in patients with malignant melanoma who presented for restaging. Metabolic PET parameters (maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG)) of the primary tumor, as well as whole-body MTV and TLG of the metastatic disease, were measured. Survival curves for OS were constructed and mortality rates were determined using the different PET variables. Forty-nine patients who presented for a PET/CT restaging in melanoma were included in this study. We found that non-survivors had significantly higher median MTV (11.86 cm3 vs. 5.68 cm3; p-value = 0.022), TLG (3125 vs. 14; p-value = 0.0357), whole-body MTV (53.9 cm3 vs. 14.4 cm3; p-value = 0.0076) and whole-body TLG (963.4 vs. 114.6; p-value = 0.0056). This demonstrated that high MTV and TLG values of the primary tumor and whole-body TLG as quantified by 18F-FDG PET/CT were prognostic factors for overall survival. The findings may potentially guide clinicians in decision making and identifying patients with a poorer prognosis.
Highlights
Melanoma is a malignant tumor that arises from the uncontrolled and rapid growth of the melanocytes, which are the pigment-producing cells of the body [1]
We investigated the association of metabolic parameters of 18F-FDG Positron emission tomography (PET)/CT in patients with melanoma undergoing restaging with overall survival
This study focused on patients who had restaging PET/CT scans and met the inclusion criteria
Summary
Melanoma is a malignant tumor that arises from the uncontrolled and rapid growth of the melanocytes, which are the pigment-producing cells of the body [1]. The most common form is cutaneous melanoma; the tumor can occur in mucosal surfaces, the eye or the brain [1]. Malignant melanoma is one of the aggressive cancers in the skin, with an increasing incidence every year. It is known to represent a small proportion of all cutaneous malignancies but causes a higher rate of fatalities in comparison to other deaths related to skin cancer [1]. Melanoma has a better prognosis if diagnosed early and survival tends to decrease once the disease has metastasized. The cost of management of melanoma contributes significantly to public health and several strategies are being implemented worldwide to improve outcomes via prevention, assessing the at-risk population and improving management strategies [1]
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