Zhao Fen, Cui Yunfeng, Li Minghuan, Fu Zheng, Chen Zhaoqiu, Kong Li, Yang Guoren, Yu Jinming
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
Nucl Med Biol. 2014 Sep;41(8):710-5. doi: 10.1016/j.nucmedbio.2014.04.134. Epub 2014 May 10.
3'-deoxy-3'-18F-fluorothymidine ([(18)F] FLT) PET has been proven to be of value in diagnosis and assessment of glioma grading, in differentiating tumor recurrence from necrosis, in response assessment and in predicting overall survival (OS) in the primary high grade glioma. In this study, we evaluated the value of [(18)F] FLT PET-CT in predicting the OS of patients with recurrent malignant glioma.
Fifty-six patients with recurrent malignant glioma were enrolled in this prospective study. The PET-CT and contrast-enhanced MRI scans were performed in all patients. Tumor volume was determined from both PET image (proliferative volume, PV) and MRI image (Vol-MRI). Patients were followed up clinically until death. The likelihood of using PET-derived parameters of SUVmax, tumor-to-normal (T/N) ratio, and PV to predict the OS of patients were assessed in comparison with Vol-MRI and other clinical parameters.
The follow up periods for all patients ranged from 1.5 to 35.6 months with median of 9.8 months. Univariate analysis showed that the following parameters were significantly correlated with OS: grade of primary tumor (p=0.042), Karnofsky performance score (KPS) (p=0.041), T/N ratio (p<0.01), Vol-MRI (p=0.041), and PV (p<0.001). However, multivariate Cox regression showed that only the PV (p<0.001) and T/N ratio (p=0.001) were independent predictors. The thresholds to predict OS were 16.88 cm(3) for PV and 10.94 for T/N ratio. Kaplan-Meier analyses using these thresholds showed a significant discrimination between short and long OS groups (p<0.001).
The PV and T/N ratio of tumor on [(18)F] FLT PET-CT are independent predictors of survival in patients with recurrent malignant glioma. The PV on [(18)F] FLT PET seems to be more predictive than tumor volume on T1-weighted MRI for OS.
3'-脱氧-3'-18F-氟胸苷（[(18)F] FLT）PET已被证明在胶质瘤分级的诊断和评估、区分肿瘤复发与坏死、疗效评估以及预测原发性高级别胶质瘤的总生存期（OS）方面具有价值。在本研究中，我们评估了[(18)F] FLT PET-CT在预测复发性恶性胶质瘤患者OS方面的价值。
56例复发性恶性胶质瘤患者纳入本前瞻性研究。所有患者均接受PET-CT和增强MRI扫描。肿瘤体积通过PET图像（增殖体积，PV）和MRI图像（Vol-MRI）确定。对患者进行临床随访直至死亡。与Vol-MRI和其他临床参数相比，评估使用PET衍生参数SUVmax、肿瘤与正常组织比值（T/N）和PV预测患者OS的可能性。
所有患者的随访期为1.5至35.6个月，中位数为9.8个月。单因素分析显示，以下参数与OS显著相关：原发肿瘤分级（p = 0.042）、卡诺夫斯基功能状态评分（KPS）（p = 0.041）、T/N比值（p < 0.01）、Vol-MRI（p = 0.041）和PV（p < 0.001）。然而，多因素Cox回归显示，只有PV（p < 0.001）和T/N比值（p = 0.001）是独立预测因素。预测OS的阈值为PV 16.88 cm(3)和T/N比值10.94。使用这些阈值进行的Kaplan-Meier分析显示，短OS组和长OS组之间有显著差异（p < 0.001）。
[(18)F] FLT PET-CT上肿瘤的PV和T/N比值是复发性恶性胶质瘤患者生存的独立预测因素。[(18)F] FLT PET上的PV似乎比T1加权MRI上的肿瘤体积对OS更具预测性。
