Schwarzbach Matthias H M, Hinz Ulf, Dimitrakopoulou-Strauss Antonia, Willeke Frank, Cardona Servando, Mechtersheimer Gunhild, Lehnert Thomas, Strauss Ludwig G, Herfarth Christian, Büchler Markus W
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Ann Surg. 2005 Feb;241(2):286-94. doi: 10.1097/01.sla.0000152663.61348.6f.
The objective of this study was to evaluate the prognostic significance of preoperative positron emission tomography (PET) using 2-fluoro-2-deoxy-D-glucose (FDG) by calculating the mean standardized uptake values (SUV) in patients with resectable soft tissue sarcomas (STS).
FDG-PET might be used as an adjunctive tool (in addition to biopsy and radiologic tomography) in the preoperative prognostic assessment of resectable STS.
A total of 74 adult patients with STS underwent preoperative FDG-PET imaging with calculation of the SUV. Clinicopathologic data and the SUV were analyzed for an association with the clinical outcome. The first and the third quartiles of the SUV distribution function were used as cutoff values (1.59 and 3.6). Survival was estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using log-rank test and the Cox proportional hazards regression model.
In 55 cases, STS were completely resected (follow up 40 months): 5-year recurrence-free survival rates in patients with SUV <1.59, 1.59 to <3.6, and > or =3.6 were 66%, 24%, and 11%, respectively (P = 0.0034). SUV was a predictor for overall survival (5-year rates: 84% [SUV <1.59], 45% [SUV 1.59 to <3.6], and 38% [SUV > or =3.6]; P = 0.057) and local tumor control (5-year rates: 93% [SUV <1.59], 43% [SUV 1.59 to <3.6], and 15% [SUV > or =3.6]; P = 0.0017). By multivariate analysis, SUV was found to be predictive for recurrence-free survival. The prognostic differences with respect to the SUV were associated with tumor grade (P = 0.002).
The semiquantitative FDG uptake, as measured by the mean SUV on preoperative PET images in patients with resectable STS, is a useful prognostic parameter. SUV with cutoff values at the first and the third quartiles of the SUV distribution predicted overall survival, recurrence-free survival, and local tumor control. Therefore, FDG-PET can be used to improve the preoperative prognostic assessment in patients with resectable STS.
本研究的目的是通过计算可切除软组织肉瘤（STS）患者术前使用2-氟-2-脱氧-D-葡萄糖（FDG）的正电子发射断层扫描（PET）的平均标准化摄取值（SUV），评估其预后意义。
FDG-PET可作为术前可切除STS预后评估的辅助工具（除活检和放射断层扫描外）。
共有74例成年STS患者接受了术前FDG-PET成像并计算SUV。分析临床病理数据和SUV与临床结果的相关性。SUV分布函数的第一和第三四分位数用作临界值（1.59和3.6）。采用Kaplan-Meier法估计生存率。使用对数秩检验和Cox比例风险回归模型进行单因素和多因素分析。
55例患者的STS被完全切除（随访40个月）：SUV<1.59、1.59至<3.6以及>或=3.6的患者5年无复发生存率分别为66%、24%和11%（P=0.0034）。SUV是总生存的预测指标（5年生存率：84%[SUV<1.59]，45%[SUV 1.59至<3.6]，38%[SUV>或=3.6]；P=0.057）和局部肿瘤控制的预测指标（5年生存率：93%[SUV<1.59]，43%[SUV 1.59至<3.6]，15%[SUV>或=3.6]；P=0.0017）。多因素分析发现，SUV是无复发生存的预测指标。SUV的预后差异与肿瘤分级相关（P=0.002）。
对于可切除STS患者，术前PET图像上通过平均SUV测量的半定量FDG摄取是一个有用的预后参数。SUV分布的第一和第三四分位数处的临界值可预测总生存、无复发生存和局部肿瘤控制。因此，FDG-PET可用于改善可切除STS患者的术前预后评估。
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