Department of Nuclear Medicine, Münster University Hospital, Münster, Germany.
J Nucl Med. 2011 Oct;52(10):1535-40. doi: 10.2967/jnumed.110.082511. Epub 2011 Sep 8.
The purpose of this retrospective study was to evaluate the role of (18)F-FDG PET or PET/CT in the prediction of patient outcome in children and young adults affected by rhabdomyosarcoma.
Forty-one patients with histology-proven rhabdomyosarcoma who underwent PET or PET/CT were identified (age range, 1-20 y; mean age ± SD, 9.9 ± 5.8 y). Tumor maximum standardized uptake value (SUV(max)) and visually rated metabolic activity, as well as the presence of metabolically active lymph nodes and distant metastases, were compared with event-free and overall survival. Multivariate Cox regression analyses were performed to compare the prediction of outcome according to metabolic tumor intensity in relation to established prognostic factors.
Kaplan-Meier analyses revealed a significantly shorter overall survival in primary tumors visually rated as highly metabolically active or with a ratio of SUV(max) to SUV of the liver above 4.6. In addition, metabolically active lymph node and distant site involvement was indicative of significantly lower survival rates. On multivariate Cox regression analysis, the impact of intensity or SUV(max) of the primary tumor on outcome failed to attain significance, although PET performed better than some of the prognostic factors established in larger patient groups (P = 0.081).
(18)F-FDG PET/CT is a valuable tool for initial staging in children affected by rhabdomyosarcoma. (18)F-FDG PET/CT may be an additional predictor of outcome and may be used to refine risk-adapted therapy. PET performed better than some established risk factors. The borderline significance level of primary tumor metabolism in multivariate testing may be an effect of the limited sample size. Further prospective evaluations are warranted.
本回顾性研究旨在评估 (18)F-FDG PET 或 PET/CT 在预测儿童和青年横纹肌肉瘤患者预后中的作用。
共纳入 41 例经组织学证实的横纹肌肉瘤患者，行 PET 或 PET/CT 检查（年龄 1-20 岁，平均年龄 ± 标准差为 9.9 ± 5.8 岁）。比较肿瘤最大标准化摄取值（SUV(max)）和代谢活性的目测评分，以及代谢活跃淋巴结和远处转移的存在情况与无事件生存和总生存的关系。采用多变量 Cox 回归分析比较代谢肿瘤强度与既定预后因素对预测结局的作用。
Kaplan-Meier 分析显示，肿瘤目测代谢活性高或 SUV(max)/肝脏 SUV 比值大于 4.6 的患者总生存率明显较短。此外，代谢活跃的淋巴结和远处转移也提示生存率显著降低。多变量 Cox 回归分析显示，尽管 PET 比较大患者组中建立的一些预后因素（P = 0.081）表现更好，但肿瘤强度或 SUV(max)对结局的影响未达到显著水平。
(18)F-FDG PET/CT 是儿童横纹肌肉瘤初始分期的一种有价值的工具。(18)F-FDG PET/CT 可能是预后的额外预测因素，并可用于优化风险适应性治疗。PET 比一些既定的危险因素表现更好。多变量检验中肿瘤代谢的边缘显著性可能是由于样本量有限的影响。需要进一步进行前瞻性评估。
