APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France.
J Neurooncol. 2012 May;107(3):527-35. doi: 10.1007/s11060-011-0771-6. Epub 2011 Dec 15.
The prognostic value of PET with (18F)-fluoro-2-deoxy-D: -glucose (FDG) has been shown in high-grade gliomas (HGG), but not compared with consensual prognostic factors. We sought to evaluate the independent predictive value of pre-treatment FDG-PET on overall (OS) and event-free survival (EFS). We retrospectively analyzed 41 patients with histologically-confirmed HGG (31 glioblastomas and 10 anaplastic gliomas). The pre-treatment uptake of FDG was assessed qualitatively by five-step visual metabolic grading, and quantitatively by the ratio between the tumor and contralateral maximal standardized uptake value (T/CL). EFS and OS following PET were compared with FDG uptake by univariate analysis, and by two multivariate analyses: one including main consensual prognostic factors (age, KPS, extent of surgery and histological grade), and the other including the classification system of the Radiation Therapy Oncology Group (Recursive Partitioning Analysis, RPA). Median OS and EFS were 13.8 and 7.4 months, respectively, for glioblastomas, and over 25.8 and 12 months, respectively, for anaplastic gliomas (P = 0.040 and P = 0.027). The T/CL ratio predicted OS in the entire group [P = 0.003; Hazard Ratio (HR) = 2.3] and in the glioblastoma subgroup (P = 0.018; HR = 2), independently of age, Karnofsky performance status, histological grade, and surgery, and independently of RPA classification. T/CL ratio tended to predict EFS in the whole group (P = 0.052). The prognostic value of visual metabolic grade on OS was less significant than T/CL ratio, both in the entire group and in the glioblastoma subgroup (P = 0.077 and P = 0.059). Quantitative evaluation of the ratio between the maximal tumor and contralateral uptake in pre-treatment FDG-PET provides significant additional prognostic information in newly-diagnosed HGG, independently of consensual prognostic factors.
正电子发射断层扫描（PET）用（18F）-氟-2-脱氧-D：-葡萄糖（FDG）在高级别神经胶质瘤（HGG）中的预后价值已得到证实，但尚未与共识预后因素进行比较。我们试图评估治疗前 FDG-PET 对总生存期（OS）和无事件生存期（EFS）的独立预测价值。我们回顾性分析了 41 例组织学证实的 HGG 患者（31 例胶质母细胞瘤和 10 例间变性神经胶质瘤）。通过五步视觉代谢分级法对 FDG 的摄取进行定性评估，并通过肿瘤与对侧最大标准化摄取值（T/CL）的比值进行定量评估。通过单变量分析和两种多变量分析比较了 PET 后 EFS 和 OS，一种分析包括主要共识预后因素（年龄、KPS、手术范围和组织学分级），另一种分析包括放射治疗肿瘤学组的分类系统（递归分区分析，RPA）。胶质母细胞瘤的中位 OS 和 EFS 分别为 13.8 个月和 7.4 个月，间变性神经胶质瘤的中位 OS 和 EFS 分别超过 25.8 个月和 12 个月（P = 0.040 和 P = 0.027）。T/CL 比值在整个组[P = 0.003；风险比（HR）= 2.3]和胶质母细胞瘤亚组[P = 0.018；HR = 2]中预测了 OS，独立于年龄、卡诺夫斯基表现状态、组织学分级和手术，独立于 RPA 分类。T/CL 比值在整个组中倾向于预测 EFS（P = 0.052）。在整个组和胶质母细胞瘤亚组中，视觉代谢分级对 OS 的预后价值均小于 T/CL 比值（P = 0.077 和 P = 0.059）。治疗前 FDG-PET 中最大肿瘤与对侧摄取比值的定量评估为新诊断的 HGG 提供了重要的附加预后信息，独立于共识预后因素。
