Division of Surgical Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Rm 54-140 CHS, Los Angeles, CA 90095, USA.
Clin Cancer Res. 2012 Apr 1;18(7):2024-31. doi: 10.1158/1078-0432.CCR-11-2139. Epub 2012 Feb 14.
Neoadjuvant therapy is associated with considerable toxicity and limited survival benefits in patients with soft tissue sarcoma (STS). We prospectively evaluated whether 2[18F]fluoro-2-deoxy-d-glucose ((18)F-FDG)-PET/computed tomographic (CT) imaging after the initial cycle of neoadjuvant therapy could predict overall survival in these patients.
Thirty-nine patients underwent (18)F-FDG-PET/CT before and after one cycle of neoadjuvant therapy. Fifty-six patients underwent end-of-treatment PET. Overall survival was, among others, correlated with changes of SUV(peak) and histopathology.
One-, two-, and five-year survival rates were 95% ± 3.0%, 86% ± 4.6%, and 68% ± 6.6%, respectively. Median time to death was 30.9 months (mean, 27.7; range, 6.9-50.1). Optimal cutoff values for early and late decreases in SUV(peak) (26% and 57%, respectively) were significant predictors of survival in univariate survival analysis [P = 0.041; HR, 0.27; 95% confidence interval (CI), 0.08-0.95 and P = 0.045; HR, 0.31; 95% CI, 0.10-0.98]. Seven of 15 early PET nonresponders but only four of 24 early PET responders died during follow-up (P = 0.068). The only other significant survival predictor was surgical margin positivity (P = 0.041; HR, 3.31; 95% CI, 1.05-10.42). By multivariable analysis, early metabolic response (P = 0.016) and positivity of surgical margins (P = 0.036) remained significant survival predictors.
(18)F-FDG-PET predicted survival after the initial cycle of neoadjuvant chemotherapy in patients with STS and can potentially serve as an intermediate endpoint biomarker in clinical research and patient care.
新辅助治疗与软组织肉瘤（STS）患者的显著毒性和有限生存获益相关。我们前瞻性评估了新辅助治疗初始周期后 2[18F]氟-2-脱氧-D-葡萄糖（18F-FDG）-正电子发射断层扫描/计算机断层扫描（PET/CT）成像是否可以预测这些患者的总生存。
39 名患者在新辅助治疗前和一周期后进行 18F-FDG-PET/CT 检查。56 名患者接受了治疗结束 PET 检查。总生存率与 SUV（峰值）和组织病理学的变化等相关。
1、2 和 5 年生存率分别为 95%±3.0%、86%±4.6%和 68%±6.6%。中位死亡时间为 30.9 个月（平均值 27.7；范围 6.9-50.1）。SUV（峰值）早期和晚期下降的最佳截断值（分别为 26%和 57%）在单因素生存分析中是生存的显著预测因子[P=0.041；HR，0.27；95%置信区间（CI），0.08-0.95 和 P=0.045；HR，0.31；95%CI，0.10-0.98]。在随访期间，15 名早期 PET 无应答者中有 7 人死亡，但 24 名早期 PET 应答者中只有 4 人死亡（P=0.068）。唯一另一个显著的生存预测因子是手术切缘阳性（P=0.041；HR，3.31；95%CI，1.05-10.42）。通过多变量分析，早期代谢反应（P=0.016）和手术切缘阳性（P=0.036）仍然是显著的生存预测因子。
18F-FDG-PET 预测了 STS 患者新辅助化疗初始周期后的生存情况，并且可能作为临床研究和患者护理中的一个潜在的中间终点生物标志物。
