FDG-PET medullary total tumor volume highlights high-risk patients with newly diagnosed multiple myeloma in CASSIOPEIA trial.

Automated bone/liver CT-based segmentation were applied to the baseline [18F]FDG-PET images, with mTMTV being defined using the median liver background as the cut-off, including focal lesions and diffuse bone marrow (BM) involvement.

在基线[18F]FDG-PET图像上应用了自动化的骨/肝CT分割，使用中位肝脏背景作为截断值来定义mTMTV，包括局灶性病变和弥漫性骨髓(BM)受累。

Both univariate/multivariate Cox and machine learning (ML)-based survival models were performed.

进行了单变量/多变量Cox和基于机器学习(ML)的生存模型分析。

A total of 195 patients were included, 81% of them PET-positive.

共纳入了195名患者，其中81%的患者PET显像阳性。

Multivariate analysis demonstrated independent prognostic value of mTMTV for progression-free survival(PFS) (P< .001) and overall survival(OS) (P< .001), complementary to Revised International Staging System (R-ISS) (P = .008 and P< .001, respectively).

多变量分析显示，mTMTV对于无进展生存期（PFS）（P< .001）和总生存期（OS）（P< .001）具有独立的预后价值，与修订版国际分期系统（R-ISS）相辅相成（分别为P = .008和P< .001）。

The ML model confirmed these findings, achieving concordance index of 0.609 and 0.659 and identifying mTMTV as the most informative feature for PFS and OS.

机器学习模型证实了这些发现，达到了一致性指数0.609和0.659，并确定mTMTV是预测PFS和OS的最有信息量的特征。

Adding R-ISS, BM maximum standardized uptake value (SUVmax) and anemia to mTMTV accounted for >60% of the ML model explanation for PFS and adding R-ISS, the number of focal lesions and BM SUVmax for >60% of the model for OS.

将R-ISS、骨髓最大标准化摄取值（SUVmax）和贫血加入到mTMTV中，解释了超过60%的PFS ML模型解释，而将R-ISS、焦点病变数量和骨髓SUVmax加入到模型中，解释了超过60%的OS模型。

Combining R-ISS and mTMTV enabled the creation of 2 new-risk subgroups.

结合R-ISS和mTMTV，可以创建2个新的风险亚组。

In conclusion, this prospective study demonstrated the prognostic relevance of [18F]FDG-PET/CT-based parameters in the initial workup of patients with NDMM in the era of anti-CD38-based therapy. mTMTV was found to have strong independent prognostic value, complementary to R-ISS and refining risk stratification.

总之，这项前瞻性研究证明了在抗CD38治疗时代，基于[18F]FDG-PET/CT的参数在新诊断多发性骨髓瘤（NDMM）患者初步评估中的预后相关性。mTMTV被发现具有强大的独立预后价值，与R-ISS相辅相成，并能进一步细化风险分层。

This trial was registered at www.clinicaltrials.gov as #NCT02541383.

这项试验已在www.clinicaltrials.gov注册，注册号为#NCT02541383。