The activity of immune checkpoint inhibitors (ICIs) in patients with metastatic melanoma is often monitored using fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans. However, distinguishing disease progression (PD) from pseudoprogression (PsPD), where increased FDG uptake might reflect immune cell activity rather than tumor growth, remains a challenge. This prospective study compared the efficacy of dual-time point (DTP) FDG-PET/CT with modified response criteria (PERCIMT) in differentiating PsPD from PD. From July 2017–January 2021, 41 patients suspected to have PsPD on an evaluation scan were prospectively included (29 evaluable). A subsequent DTP FDG-PET/CT scan was conducted within 14 days, followed by a confirmatory FDG-PET/CT scan. Additionally, PERCIMT were applied. DTP FDG-PET/CT identified 24% with PsPD and 76% with PD. Applying PERCIMT criteria, 69% showed PsPD, while 31% had PD. On follow-up, 10 patients (34%) demonstrated confirmed PsPD, while 19 (66%) exhibited PD. The sensitivity and specificity of DTP FDG-PET/CT were 20% and 74%, respectively, and for PERCIMT this was 80% and 37%, respectively. Our findings suggest limited efficacy of DTP FDG-PET/CT in distinguishing PsPD from PD in ICI-treated patients with metastatic melanoma. The use of PERCIMT could complement clinical assessment and be incorporated in multidisciplinary team conferences for enhanced decision-making.
转移性黑色素瘤患者接受免疫检查点抑制剂治疗时，常采用氟-18-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描进行疗效监测。然而，如何区分疾病进展与假性进展——即FDG摄取增高可能反映免疫细胞活性而非肿瘤生长——仍是临床挑战。本前瞻性研究比较了双时相FDG-PET/CT与改良疗效标准在鉴别假性进展与疾病进展中的效能。2017年7月至2021年1月期间，共前瞻性纳入41例评估扫描疑似假性进展的患者（其中29例可评估）。在14天内进行双时相FDG-PET/CT扫描，随后进行验证性FDG-PET/CT扫描，同时应用PERCIMT标准进行评估。双时相FDG-PET/CT判定24%为假性进展，76%为疾病进展；而应用PERCIMT标准显示69%为假性进展，31%为疾病进展。随访证实10例患者（34%）为假性进展，19例（66%）为疾病进展。双时相FDG-PET/CT的敏感性与特异性分别为20%和74%，PERCIMT标准则分别为80%和37%。本研究提示双时相FDG-PET/CT在鉴别免疫检查点抑制剂治疗的转移性黑色素瘤患者假性进展与疾病进展方面效能有限。PERCIMT标准可作为临床评估的补充工具，并纳入多学科团队讨论以优化临床决策。
肿瘤(癌症)患者之家