18F-FDG-PET/CT Imaging as an early survival predictor in patients with primary high-grade soft tissue sarcomas undergoing neoadjuvant therapy.
18F-FDG-PET/CT Imaging as an early survival predictor in patients with primary high-grade soft tissue sarcomas undergoing neoadjuvant therapy.
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DOI：
10.1158/1078-0432.ccr-11-2139
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发表时间：
2012-04-01
期刊：
影响因子：
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通讯作者：
Eilber FC
中科院分区：
文献类型：
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作者：
Herrmann K;Benz MR;Czernin J;Allen-Auerbach MS;Tap WD;Dry SM;Schuster T;Eckardt JJ;Phelps ME;Weber WA;Eilber FC
在软组织肉瘤（STS）患者中，新辅助治疗与相当大的毒性和有限的生存益处相关。我们前瞻性评估了新辅助治疗初始周期后2[18F]氟-2-脱氧-d-葡萄糖(18F- fdg)-PET/计算机断层扫描（CT）成像是否可以预测这些患者的总生存期。39例患者在新辅助治疗前后分别行18F-FDG-PET/CT检查。56例患者在治疗结束后接受了PET检查。总生存率与SUVpeak和组织病理学的变化有关。1年、2年和5年生存率分别为95%±3.0%、86%±4.6%和68%±6.6%。中位死亡时间为30.9个月（平均27.7个月，范围6.9-50.1个月）。单因素生存分析中，早期和晚期SUVpeak下降的最佳临界值（分别为26%和57%）是显著的生存预测因子[P = 0.041；人力资源,0.27;95%置信区间（CI）为0.08 ~ 0.95,P = 0.045；人力资源,0.31;95% ci, 0.10-0.98]。随访期间，15例早期PET无应答者中有7例死亡，24例早期PET应答者中仅有4例死亡（P = 0.068）。其他唯一显著的生存预测因子是手术切缘阳性（P = 0.041； HR, 3.31; 95% CI, 1.05-10.42）。通过多变量分析，早期代谢反应（P = 0.016）和手术切缘阳性（P = 0.036）仍然是显著的生存预测因子。18F-FDG-PET预测STS患者新辅助化疗初始周期后的生存，可能作为临床研究和患者护理的中间终点生物标志物。
Neoadjuvant therapy is associated with considerable toxicity and limited survival benefits in patients with soft tissue sarcoma (STS). We prospectively evaluated whether 2[18F]fluoro-2-deoxy-d-glucose (18F-FDG)-PET/computed tomographic (CT) imaging after the initial cycle of neoadjuvant therapy could predict overall survival in these patients. Thirty-nine patients underwent 18F-FDG-PET/CT before and after one cycle of neoadjuvant therapy. Fifty-six patients underwent end-of-treatment PET. Overall survival was, among others, correlated with changes of SUVpeak and histopathology. One-, two-, and five-year survival rates were 95% ± 3.0%, 86% ± 4.6%, and 68% ± 6.6%, respectively. Median time to death was 30.9 months (mean, 27.7; range, 6.9–50.1). Optimal cutoff values for early and late decreases in SUVpeak (26% and 57%, respectively) were significant predictors of survival in univariate survival analysis [P = 0.041; HR, 0.27; 95% confidence interval (CI), 0.08–0.95 and P = 0.045; HR, 0.31; 95% CI, 0.10–0.98]. Seven of 15 early PET nonresponders but only four of 24 early PET responders died during follow-up (P = 0.068). The only other significant survival predictor was surgical margin positivity (P = 0.041; HR, 3.31; 95% CI, 1.05–10.42). By multivariable analysis, early metabolic response (P = 0.016) and positivity of surgical margins (P = 0.036) remained significant survival predictors. 18F-FDG-PET predicted survival after the initial cycle of neoadjuvant chemotherapy in patients with STS and can potentially serve as an intermediate endpoint biomarker in clinical research and patient care.