背景：尽管联合应用伊匹单抗和尼伐单抗（以下简称IpiNivo）治疗晚期黑色素瘤的反应有所改善，但许多患者表现出原发性或获得性抗药性。加上免疫相关不良事件的高风险，因此需要确定预测结果的标记。 目的：研究在接受IpiNivo治疗的晚期黑色素瘤患者中，基线和作为响应监测的氟18（18F）脱氧葡萄糖正电子发射断层扫描（FDG PET / CT）参数的预后价值。 材料和方法：这是一项单中心回顾性研究，纳入接受IpiNivo治疗的成年黑色素瘤患者。将包括代谢肿瘤体积（MTV）、肿瘤分期、突变状态、东部合作肿瘤组织绩效评分、乳酸脱氢酶水平和治疗线的基线FDG PET/CT参数与总生存期在单变量和多变量Cox回归分析中相关联。确定FDG PET/CT作为治疗响应的相关性与总生存期。 结果：总共纳入122例患者（年龄中位数为61岁[IQR，51-69岁]; 男性89人），其中78％（122中的95）的东部合作肿瘤组织绩效评分为0，52％（86中的45）患有高乳酸脱氢酶水平，39％（122中的48）为M1c转移期和45％（122中的55）为M1d转移期，45％（122中的55）具有BRAF V600E / K突变，中位数MTV为42 mL。在基线FDG PET/CT中具有高于中位数MTV的患者与低于中位数MTV的患者相比，12个月的生存率较低（43％[95％CI：32, 58] vs 66％[95％CI：55, 79]，P <0.001）。在多变量分析中，高于中位数的MTV，东部合作肿瘤组织绩效评分1-2与0，以及后续与一线IpiNivo治疗与总生存期独立相关（风险比[HR]：1.68 [95％CI：1.02, 2.78]，P = 0.04; 3.1 [95％CI：1.8，5.4]，P <0.001;和11.2 [95％CI：3.4, 37.1]，P = 0.002）。进展性疾病的患者的12个月总生存率低于没有进展的患者（35％[95％CI：24，51] vs 90％[95％CI：83, 99]; HR，7.3 [95％CI：3.9, 13.3]; P <0.001）。 结论：基线的氟18脱氧葡萄糖PET / CT代谢肿瘤体积是接受伊匹单抗和尼伐单抗治疗的晚期黑色素瘤患者的独立预后标记。 ©RSNA，2023本文有补充材料。

Background Despite improved response to combined ipilimumab and nivolumab (hereafter, IpiNivo) treatment for advanced melanoma, many patients exhibit primary or acquired resistance. This, combined with high risk of immune-related adverse events, makes identifying markers predictive of outcomes desirable. Purpose To investigate the prognostic value of fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT parameters at baseline and as part of response monitoring in patients with advanced melanoma undergoing IpiNivo treatment. Materials and Methods This was a single-center retrospective study of adult patients with melanoma who received IpiNivo. Baseline FDG PET/CT parameters that included metabolic tumor volume (MTV), tumor stage, mutation status, Eastern Cooperative Oncology Group performance score, lactate dehydrogenase level, and treatment line were correlated with overall survival in univariable and multivariable Cox regression analyses. Treatment response as determined with FDG PET/CT was correlated with overall survival. Results In total, 122 patients (median age, 61 years [IQR, 51-69 years]; 89 men) were included; 78% (95 of 122) had an Eastern Cooperative Oncology Group score of 0, 52% (45 of 86) had an elevated lactate dehydrogenase level, 39% (48 of 122) had a metastatic stage of M1c and 45% (55 of 122) M1d, 45% (55 of 122) had BRAF V600E/K mutation, and the median MTV was 42 mL. Patients with a higher than median MTV at baseline FDG PET/CT had a lower 12-month survival rate compared with those with a lower than median MTV (43% [95% CI: 32, 58] vs 66% [95% CI: 55, 79], P < .001). In multivariable analysis, higher versus lower than median MTV, Eastern Cooperative Oncology Group performance scores of 1-2 versus 0, and subsequent versus first-line IpiNivo treatment were independently associated with overall survival (hazard ratio [HR]: 1.68 [95% CI: 1.02, 2.78], P = .04; 3.1 [95% CI: 1.8, 5.4], P < .001; and 11.2 [95% CI: 3.4, 37.1], P = .002, respectively). The 12-month overall survival rate was lower in patients with progressive disease than in those without progression (35% [95% CI: 24, 51] vs 90% [95% CI: 83, 99]; HR, 7.3 [95% CI: 3.9, 13.3]; P < .001). Conclusion Baseline fluorine 18 fluorodeoxyglucose PET/CT metabolic tumor volume was an independent prognostic marker in patients with advanced melanoma who received ipilimumab and nivolumab treatment. © RSNA, 2023 Supplemental material is available for this article.