Improved risk stratification by PET-based intratumor heterogeneity in children with high-risk neuroblastoma.
Improved risk stratification by PET-based intratumor heterogeneity in children with high-risk neuroblastoma.
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基于 PET 的肿瘤内异质性改善了高危神经母细胞瘤儿童的风险分层
DOI：
10.3389/fonc.2022.896593
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发表时间：
2022
影响因子：
4.7
通讯作者：
Chen, Suyun
中科院分区：
文献类型：
--
作者：
Li, Chao;Wang, Shaoyan;Li, Can;Yin, Yafu;Feng, Fang;Fu, Hongliang;Wang, Hui;Chen, Suyun
目的：高危神经母细胞瘤的亚分层具有挑战性，新的预测性成像生物标志物是更好地选择患者的保证。该研究的目的是评估基于PET的肿瘤内异质性的预后作用及其改善神经母细胞瘤风险分层的潜在能力。方法回顾性分析112例初诊神经母细胞瘤患儿治疗前的18F-FDG PET/CT扫描结果。在PET图像中分割原发肿瘤。提取SUV、体积参数（包括代谢肿瘤体积（MTV）和总病变糖酵解（TLG））和纹理特征。在排除具有较差和中等重现性的影像学特征后，评估了影像学指标与临床病理因素以及无事件生存期（EFS）之间的关系。结果中位随访时间为33个月。多变量分析显示，基于PET的肿瘤内异质性优于临床病理特征，包括年龄、分期和MYCN，并且仍然是EFS的最稳健的独立预测因子[训练集，风险比（HR）：6.4，95%CI：3.1-13.2，p < 0.001;测试集，HR：5.0，95%CI：1.8-13.6，p = 0.002]。在临床高风险组中，与肿瘤相对同质的患者相比，具有高代谢异质性的患者显示出显著较差的结局（训练集中HR：3.3，95% CI：1.6-6.8，p = 0.002;测试集中HR：4.4，95% CI：1.5-12.9，p = 0.008）。此外，肿瘤内异质性超过体积指数（MTV和TLG），并在区分具有不同结局的高危患者方面表现最佳，训练集3年EFS为6% vs. 47%（p = 0.001），测试集为9% vs. 51%（p = 0.004）。结论基于PET的瘤内异质性是神经母细胞瘤的一个独立预后因素。在临床高风险组中，肿瘤内异质性进一步分层患者具有不同的结果。
Purpose The substratification of high-risk neuroblastoma is challenging, and new predictive imaging biomarkers are warranted for better patient selection. The aim of the study was to evaluate the prognostic role of PET-based intratumor heterogeneity and its potential ability to improve risk stratification in neuroblastoma. Methods Pretreatment 18F-FDG PET/CT scans from 112 consecutive children with newly diagnosed neuroblastoma were retrospectively analyzed. The primary tumor was segmented in the PET images. SUVs, volumetric parameters including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), and texture features were extracted. After the exclusion of imaging features with poor and moderate reproducibility, the relationships between the imaging indices and clinicopathological factors, as well as event-free survival (EFS), were assessed. Results The median follow-up duration was 33 months. Multivariate analysis showed that PET-based intratumor heterogeneity outperformed clinicopathological features, including age, stage, and MYCN, and remained the most robust independent predictor for EFS [training set, hazard ratio (HR): 6.4, 95% CI: 3.1–13.2, p < 0.001; test set, HR: 5.0, 95% CI: 1.8–13.6, p = 0.002]. Within the clinical high-risk group, patients with a high metabolic heterogeneity showed significantly poorer outcomes (HR: 3.3, 95% CI: 1.6–6.8, p = 0.002 in the training set; HR: 4.4, 95% CI: 1.5–12.9, p = 0.008 in the test set) compared to those with relatively homogeneous tumors. Furthermore, intratumor heterogeneity outran the volumetric indices (MTVs and TLGs) and yielded the best performance of distinguishing high-risk patients with different outcomes with a 3-year EFS of 6% vs. 47% (p = 0.001) in the training set and 9% vs. 51% (p = 0.004) in the test set. Conclusion PET-based intratumor heterogeneity was a strong independent prognostic factor in neuroblastoma. In the clinical high-risk group, intratumor heterogeneity further stratified patients with distinct outcomes.
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影响因子：
9.3
作者：
Hatt, Mathieu;Majdoub, Mohamed;Visvikis, Dimitris
通讯作者：
Visvikis, Dimitris
影响因子：
45.3
作者：
Katzenstein, HM;Cohn, SL;Kletzel, M
通讯作者：
Kletzel, M
影响因子：
9.3
作者：
Papathanasiou, Nikolaos D.;Gaze, Mark N.;Bomanji, Jamshed B.
通讯作者：
Bomanji, Jamshed B.
影响因子：
11.5
作者：
Basler, Lucas;Gabrys, Hubert S.;Levesque, Mitchell P.
通讯作者：
Levesque, Mitchell P.
影响因子：
3.8
作者：
Pfaehler E;Mesotten L;Zhovannik I;Pieplenbosch S;Thomeer M;Vanhove K;Adriaensens P;Boellaard R
通讯作者：
Boellaard R