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. 2021 Feb 24;18(8):1857-1865.
doi: 10.7150/ijms.58263. eCollection 2021.

Value of pretreatment 18F-FDG PET/CT in prognosis and the reflection of tumor burden: a study in pediatric patients with newly diagnosed neuroblastoma

Shuai Man  1 , Jie Yan  1 , Jie Li  1 , Yanna Cao  1 , Jiajian Hu  1 , Wenchao Ma  2 , Jianjing Liu  2 , Qiang Zhao  1
Affiliations

Value of pretreatment 18F-FDG PET/CT in prognosis and the reflection of tumor burden: a study in pediatric patients with newly diagnosed neuroblastoma

Shuai Man et al. Int J Med Sci. .

Abstract

Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT has been commonly used in pediatric patients with newly diagnosed neuroblastoma (NB) for diagnosis. We retrospectively reviewed 40 pediatric patients with newly diagnosed NB who underwent 18F-FDG PET/CT. Clinicopathological factors and metabolic parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were evaluated as predictive factors for progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analysis. Spearman rank correlation analyses were used to estimate the correlations between clinical factors and PET findings. The mean follow-up after 18F-FDG-PET/CT was 32.9 months. During the follow-up period 15 (37.5%) patients experienced progression, and 9 (22.5%) died. MTV (P=0.001) and TLG (p=0.004) remained significant predictive factors for tumor progression, along with lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and bone metastasis. Univariate analysis showed that bone metastasis, LDH (>1064 IU/L), NSE (>364.4 ug/L), MTV (>191 cm3) and TLG (>341.41 g) correlated with PFS, and LDH (>1064 IU/L), NSE (>364.4 ug/L) and MTV (>191 cm3) correlated with OS (p<0.05). In multivariate analysis, MTV and bone metastasis were independent prognostic factors for PFS (p=0.001 and 0.023, respectively), and MTV remained the only independent prognostic factor for OS (p= 0.004). We also found that there were correlations between semiquantitative PET/CT parameters and clinical features in NB. Our results suggested that 18F-FDG PET/CT was a useful tool to predictive progression and to reflect tumor burden for patients with NB.

Keywords: 18F-FDG PET/CT; MTV; TLG; neuroblastoma; progression; tumor burden.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Cumulative progression-free survival (PFS) curves according to (A) metabolic tumor volume (MTV) and (B) bone metastasis and (C)cumulative overall survival (OS) curve according to MTV of NB lesions in enrolled patients.
Figure 2
Figure 2
A-C) Representative images of a 1-year-old boy with stage IV NB. PET/CT revealed a primary tumor at the left suprarenal region, seen in the (A) coronal, (B) axial and (C) sagittal views. Intense metabolic tumor volume (MTV) (236) of the primary tumor was noted on the axial image. He progressed and eventually died. D-F) Representative images of a 4-year-old girl with stage IV NB. PET/CT revealed the primary tumor at left suprarenal region, seen in the (D) coronal, (E) axial, and (F) sagittal views. Small metabolic tumor volume (MTV) (46.9) of the primary tumor was noted on the axial image. She has not progressed yet.
Figure 3
Figure 3
NB. Whole body PET/CT shows NB in the left adrenal gland. Bone marrow infiltration in the left and right femur head as well as the proximal tibia. (A) Activity in the right pelvis was observed. (B)Bone marrow infiltration in the left and right femurs. This patient had a large SUVmax-ratio value, 8.781, and eventually the patient progressed, and eventually died, with very short progression-free survival (PFS) and overall survival (OS).
Figure 4
Figure 4
Spearman correlation analyses indicating a strong correlation between lactate dehydrogenase (LDH) and (A) total lesion glycolysis (TLG) or (B) metabolic tumor volume (MTV). Spearman correlation analyses indicating a strong correlation between the neuron‑specific enolase (NSE) level and (C) metabolic tumor volume (MTV), (D) total lesion glycolysis (TLG) or (E) SUVmax
See this image and copyright information in PMC

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