The prognostic value of (18)F-FDG PET/CT intra-tumoural metabolic heterogeneity in pretreatment neuroblastoma patients.
The prognostic value of (18)F-FDG PET/CT intra-tumoural metabolic heterogeneity in pretreatment neuroblastoma patients.
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DOI：
10.1186/s40644-022-00472-4
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发表时间：
2022-07-05
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神经母细胞瘤(NB)是5岁以下儿童最常见的肿瘤，以高度异质性著称。我们的目的是利用18F-FDGPET/CT定量检测原发肿瘤病灶的肿瘤内代谢异质性，并评价肿瘤内代谢异质性对NB患者预后的价值。在我们的研究中，我们回顾了38名接受治疗的NB患者。对18F-FDG PET/CT图像进行复习，并用3D Slector软件进行分析。测量肿瘤的半定量代谢参数，包括最大标准摄取值(SUVmax)、代谢肿瘤体积(MTV)和总病变糖酵解(TLG)。用累积SUV体积直方图指数(AUC-CSH指数)曲线下面积来量化肿瘤内代谢的异质性。中位随访时间为21.3个月(3.6~33.4个月)。结果终点为无事件生存(EFS)，包括无进展生存和总生存。生存分析采用Cox回归模型和Kaplan Meier生存图。在所有38例新诊断的NB患者中，2例死亡，17例复发。AUC-CSH总量(r=0.630，P<；0.001)与AUC-CSH40%呈中度相关。单因素分析显示，染色体11q缺失(P=0.033)、儿童肿瘤组危险分组(P=0.009)、骨髓受累(P=0.015)和AUC-CSH总数(P=0.007)与EFS相关。在多因素分析中，AUC-CSH总量(P=0.036)和体重指数(P=0.045)仍有显著意义。Kaplan Meier生存分析显示，肿瘤内代谢异质性和体重指数越高的患者预后越差(对数等级P=0.002)。Nb原发病灶的瘤内代谢异质性是EFS的独立预后因素。肿瘤内代谢异质性和BMI的联合预测作用提供了NB患者的预后生存信息。
Neuroblastoma (NB) is the most common tumour in children younger than 5 years old and notable for highly heterogeneous. Our aim was to quantify the intra-tumoural metabolic heterogeneity of primary tumour lesions by using 18F-FDG PET/CT and evaluate the prognostic value of intra-tumoural metabolic heterogeneity in NB patients. We retrospectively enrolled 38 pretreatment NB patients in our study. 18F-FDG PET/CT images were reviewed and analyzed using 3D slicer software. The semi-quantitative metabolic parameters of primary tumour were measured, including the maximum standard uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG). The areas under the curve of cumulative SUV-volume histogram index (AUC-CSH index) was used to quantify intra-tumoural metabolic heterogeneity. The median follow-up was 21.3 months (range 3.6 - 33.4 months). The outcome endpoint was event-free survival (EFS), including progression-free survival and overall survival. Survival analysis was performed using Cox regression models and Kaplan Meier survival plots. In all 38 newly diagnosed NB patients, 2 patients died, and 17 patients experienced a relapse. The AUC-CSHtotal (r=0.630, P<0.001) showed moderate correlation with the AUC-CSH40%. In univariate analysis, chromosome 11q deletion (P=0.033), Children's Oncology Group (COG) risk grouping (P=0.009), bone marrow involvement (BMI, P=0.015), and AUC-CSHtotal (P=0.007) were associated with EFS. The AUC-CSHtotal (P=0.036) and BMI (P=0.045) remained significant in multivariate analysis. The Kaplan Meier survival analyses demonstrated that patients with higher intra-tumoural metabolic heterogeneity and BMI had worse outcomes (log-rank P=0.002). The intra-tumoural metabolic heterogeneity of primary lesions in NB was an independent prognostic factor for EFS. The combined predictive effect of intra-tumoural metabolic heterogeneity and BMI provided prognostic survival information in NB patients.