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Purpose <p>Cutaneous melanoma (CM) is an aggressive malignancy with rising incidence. Immune checkpoint blockades (ICBs), particularly anti–PD-1 therapies, have improved survival in metastatic CM. However, many patients show primary resistance or develop progression after initial benefit. Early identification of patients likely to benefit remains a clinical challenge. Total Metabolic Tumor Volume (TMTV) and the maximum distance between two lesions (Dmax), derived from baseline [18F]FDG-PET/CT, have shown prognostic relevance in other cancers. This study evaluates their prognostic value in metastatic CM.</p> Methods <p>This retrospective study included 143 patients with metastatic CM treated with ICBs (2016–2023) across two centers. Tumor lesions were segmented using PERCIST procedure on baseline (PET0) and early follow-up (PET1, 9–12&#xa0;weeks post-treatment) [18F]FDG-PET/CT. TMTV, Dmax, and their changes (ΔTMTV, ΔDmax) were calculated. Associations with progression-free survival (PFS) and overall survival (OS) were assessed, including in multivariable analyses.</p> Results <p>Elevated Dmax (above median) at PET0 was independently linked to poorer PFS (HR = 1.67; 95% confidence interval (CI): 1.03–2.71; <i>p =</i> 0.036) and OS (HR = 2.03; 95% CI: 1.20–3.43; <i>p =</i> 0.009). Stable or increased TMTV and Dmax between PET0 and PET1 (ΔTMTV and ΔDmax ≥ 0%) correlated with significantly worse outcomes. Using PET0 TMTV and Dmax, as well as ΔTMTV and ΔDmax considered separately, allowed stratification into three risk groups with distinct prognoses.</p> Conclusion <p>Baseline TMTV and Dmax, along with their early changes, are strong prognostic markers in metastatic CM treated with ICBs. Their integration into clinical practice may enhance early risk stratification and inform personalized therapeutic strategies.</p>

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Prognostic value of TMTV and Dmax calculated from 18F-fluorodeoxyglucose positron emission tomography images in metastatic cutaneous melanoma treated with immune checkpoint blockade

  • 期刊论文

  • 发表日期：

    2026年2月17日

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  • Karim Amrane,
  • Bastien Cabarrou,
  • Coline Le Meur,
  • David Bourhis,
  • Olivier Pradier,
  • Laurent Misery,
  • Delphine Legoupil,
  • Maxime Etienne,
  • Georges-Philippe Fontaine,
  • Pierre-Yves Salaun,
  • Irène Buvat,
  • Fanny Orlhac,
  • Ronan Abgral

摘要

Purpose

Cutaneous melanoma (CM) is an aggressive malignancy with rising incidence. Immune checkpoint blockades (ICBs), particularly anti–PD-1 therapies, have improved survival in metastatic CM. However, many patients show primary resistance or develop progression after initial benefit. Early identification of patients likely to benefit remains a clinical challenge. Total Metabolic Tumor Volume (TMTV) and the maximum distance between two lesions (Dmax), derived from baseline [18F]FDG-PET/CT, have shown prognostic relevance in other cancers. This study evaluates their prognostic value in metastatic CM.

Methods

This retrospective study included 143 patients with metastatic CM treated with ICBs (2016–2023) across two centers. Tumor lesions were segmented using PERCIST procedure on baseline (PET0) and early follow-up (PET1, 9–12 weeks post-treatment) [18F]FDG-PET/CT. TMTV, Dmax, and their changes (ΔTMTV, ΔDmax) were calculated. Associations with progression-free survival (PFS) and overall survival (OS) were assessed, including in multivariable analyses.

Results

Elevated Dmax (above median) at PET0 was independently linked to poorer PFS (HR = 1.67; 95% confidence interval (CI): 1.03–2.71; p = 0.036) and OS (HR = 2.03; 95% CI: 1.20–3.43; p = 0.009). Stable or increased TMTV and Dmax between PET0 and PET1 (ΔTMTV and ΔDmax ≥ 0%) correlated with significantly worse outcomes. Using PET0 TMTV and Dmax, as well as ΔTMTV and ΔDmax considered separately, allowed stratification into three risk groups with distinct prognoses.

Conclusion

Baseline TMTV and Dmax, along with their early changes, are strong prognostic markers in metastatic CM treated with ICBs. Their integration into clinical practice may enhance early risk stratification and inform personalized therapeutic strategies.