3′-Deoxy-3′-18F-Fluorothymidine PET-Derived Proliferative Volume Predicts Overall Survival in High-Grade Glioma Patients
3′-Deoxy-3′-18F-Fluorothymidine PET-Derived Proliferative Volume Predicts Overall Survival in High-Grade Glioma Patients
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DOI：
10.2967/jnumed.112.105544
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发表时间：
2012-12-01
影响因子：
9.3
通讯作者：
Oyen, Wim J. G.
中科院分区：
文献类型：
--
作者：
Idema, Albert J. S.;Hoffmann, Aswin L.;Oyen, Wim J. G.
3'-脱氧-3'- f -18-氟胸苷（F-18-FLT）是一种用PET描述肿瘤细胞增殖的放射性药物。在肺、乳腺、头颈部、消化道、脑和其他器官的恶性肿瘤中，F-18-FLT靶向的定量评估已被证明与增殖标志物Ki-67以及临床结果指标（如进展时间和总生存期（OS））相关。本研究的目的是评估各种PET分割方法来估计高级别胶质瘤患者的增殖体积（PV）及其对OS的预后价值。方法：连续26例患者术前行F-18-FLT PET/CT和对比剂应用后的t1加权MRI检查。计算所有肿瘤的最大标准化摄取值（SUVmax），并使用3种不同的分割方法来估计PV: SUVmax信号的50%等高作为PV50%，信号与背景比（SBR）作为自适应阈值划定（PVSBR）方法，迭代背景减去相对阈值水平（RTL）方法来估计PVRTL。评估SUVmax和不同pv对OS的预后价值。结果：多形性胶质母细胞瘤22例，间变性少突胶质细胞瘤2例，间变性室管膜瘤1例，间变性星形细胞瘤1例。中位OS为397 d(95%可信区间，204-577)；随访期间死亡19例。PVSBR与OS的相关性显著高于SUVmax、PVRTL和PV50% （P = 0.002）。接受者操作特征分析得出PVSBR的阈值体积为11.4 cm(3)，预测OS的敏感性和特异性分别为70%和83%。Kaplan-Meier分析显示，该阈值在短OS和长OS之间存在显著差异（P = 0.024, log rank）。结论：F-18-FLT PET检测的PV与恶性胶质瘤的OS相关。SBR方法预测短期和长期生存期的效果最好。
3'-deoxy-3'-F-18-fluorothymidine (F-18-FLT) is a radiopharmaceutical depicting tumor cell proliferation with PET. In malignancies of the lung, breast, head and neck, digestive tract, brain, and other organs, quantitative assessment of F-18-FLT targeting has been shown to correlate with the proliferation marker Ki-67 and with clinical outcome measures such as time to progression and overall survival (OS). The aim of this study was to assess various PET segmentation methods to estimate the proliferative volume (PV) and their prognostic value for OS in patients with suspected high-grade glioma. Methods: Twenty-six consecutive patients underwent preoperative F-18-FLT PET/CT and T1-weighted MRI of the brain after contrast application. The maximum standardized uptake value (SUVmax) of all tumors was calculated, and 3 different segmentation methods for estimating the PV were used: the 50% isocontour of the SUVmax signal for the PV50%, the signal-to-background ratio (SBR) for an adaptive threshold delineation (PVSBR) method, and the iterative background-subtracted relative threshold level (RTL) method to estimate the PVRTL. The prognostic value of the SUVmax and the different PVs for OS were assessed. Results: Twenty-two patients had glioblastoma multiforme, 2 had anaplastic oligodendroglioma, 1 had anaplastic ependymoma, and 1 had anaplastic astrocytoma. The median OS was 397 d (95% confidence interval, 204-577); 19 patients died during the follow-up period. The PVSBR showed a significantly (P = 0.002) better association with OS than did SUVmax, PVRTL, and PV50%. Receiver-operating-characteristic analysis resulted in a threshold volume for the PVSBR of 11.4 cm(3), with a sensitivity and specificity of 70% and 83%, respectively, for the prediction of OS. Kaplan-Meier analyses showed a significant discrimination between short and long OS (P = 0.024, log rank) for this threshold. Conclusion: The PV as determined by F-18-FLT PET is associated with OS in high-grade malignant gliomas. The SBR method yielded the best results to predict short and long OS.