Background: Colorectal cancer (CRC) remains a major global health concern, with increasing incidence and mortality projected over the coming decades. Despite the central role of staging systems, substantial heterogeneity in clinical outcomes persists among patients within the same stage, highlighting the need for additional prognostic biomarkers. This study aimed to evaluate whether segmentation-derived morphological and metabolic features of the primary tumor could serve as prognostic biomarkers associated with subsequent tumor evolution in CRC. Methods: In this retrospective, single-center study, 91 patients with histologically confirmed CRC who underwent baseline FDG PET/CT prior to treatment were analyzed. Morphological (tumor shape, cranio-caudal extension, volume) and metabolic (SUVmean, SUVmax, MTV, TLG) parameters of the primary tumor were extracted using 3D segmentation. Clinical benefit (CB) was defined according to RECIST criteria at six months. Logistic regression and Cox proportional hazards models were applied to identify predictors of short- and long-term outcomes, with performance assessed using ROC curves and Kaplan–Meier survival analyses. Results: Cranio-caudal extension was the strongest prognostic biomarker of short-term clinical benefit (AUC = 0.89), with a threshold of 6.2 cm discriminating favorable from unfavorable outcomes. In multivariate analysis, early UICC stage and lower cranio-caudal extension were independently associated with CB. For long-term outcomes, MTV emerged as a consistent prognostic factor: higher MTV predicted shorter progression-free survival (HR = 1.03,p< 0.01) and overall survival (HR = 1.03,p< 0.01). In addition, UICC stage IV significantly increased the risk of progression (HR = 9.65,p< 0.01). Conclusions: Segmentation of the primary tumor on baseline FDG PET/CT provides valuable prognostic information in CRC. While cranio-caudal extension was the strongest prognostic biomarker of short-term treatment response, MTV was independently associated with long-term outcomes, particularly progression-free survival. These findings highlight the complementary prognostic roles of morphological and metabolic tumor features and support the integration of PET/CT-based biomarkers into personalized treatment strategies for colorectal cancer.
背景：结直肠癌（CRC）作为全球重大健康问题，其发病率和死亡率预计在未来数十年将持续上升。尽管分期系统在临床评估中具有核心地位，但相同分期患者间仍存在显著的临床结局异质性，这凸显了对额外预后生物标志物的需求。本研究旨在评估基于原发肿瘤分割提取的形态学与代谢特征，能否作为预测结直肠癌后续肿瘤演变的预后生物标志物。 方法：本项回顾性单中心研究纳入了91例经组织学确诊的结直肠癌患者，所有患者在治疗前均接受了基线FDG PET/CT检查。通过三维分割技术提取原发肿瘤的形态学参数（肿瘤形状、头尾向延伸长度、体积）和代谢参数（SUVmean、SUVmax、MTV、TLG）。临床获益（CB）根据六个月时的RECIST标准进行判定。采用逻辑回归和Cox比例风险模型分别识别短期与长期结局的预测因子，并通过ROC曲线和Kaplan-Meier生存分析评估模型性能。 结果：头尾向延伸长度是短期临床获益最强的预后生物标志物（AUC = 0.89），以6.2 cm为阈值可有效区分预后良好与不良患者。多变量分析显示，早期UICC分期和较小的头尾向延伸长度与临床获益独立相关。在长期结局方面，MTV呈现为稳定的预后因子：较高的MTV预示着较短的无进展生存期（HR = 1.03, p < 0.01）和总生存期（HR = 1.03, p < 0.01）。此外，UICC IV期显著增加疾病进展风险（HR = 9.65, p < 0.01）。 结论：基于基线FDG PET/CT的原发肿瘤分割能为结直肠癌提供有价值的预后信息。头尾向延伸长度是短期治疗反应最强的预后生物标志物，而MTV则与长期结局（特别是无进展生存期）独立相关。这些发现揭示了肿瘤形态学特征与代谢特征的互补性预后价值，支持将基于PET/CT的生物标志物整合到结直肠癌个体化治疗策略中。
肿瘤(癌症)患者之家