Lopci Egesta, Riva Marco, Olivari Laura, Raneri Fabio, Soffietti Riccardo, Piccardo Arnoldo, Bizzi Alberto, Navarria Pierina, Ascolese Anna Maria, Rudà Roberta, Fernandes Bethania, Pessina Federico, Grimaldi Marco, Simonelli Matteo, Rossi Marco, Alfieri Tommaso, Zucali Paolo Andrea, Scorsetti Marta, Bello Lorenzo, Chiti Arturo
Nuclear Medicine, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy.
Neurosurgery, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.
Eur J Nucl Med Mol Imaging. 2017 Jul;44(7):1155-1164. doi: 10.1007/s00259-017-3618-3. Epub 2017 Jan 21.
We evaluated the relationship between C-methionine PET (C-METH PET) findings and molecular biomarkers in patients with supratentorial glioma who underwent surgery.
A consecutive series of 109 patients with pathologically proven glioma (64 men, 45 women; median age 43 years) referred to our Institution from March 2012 to January 2015 for tumour resection and who underwent preoperative C-METH PET were analysed. Semiquantitative evaluation of the C-METH PET images included SUVmax, region of interest-to-normal brain SUV ratio (SUVratio) and metabolic tumour volume (MTV). Imaging findings were correlated with disease outcome in terms of progression-free survival (PFS), and compared with other clinical biological data, including IDH1 mutation status, 1p/19q codeletion and MGMT promoter methylation. The patients were monitored for a mean period of 16.7 months (median 13 months).
In all patients, the tumour was identified on C-METH PET. Significant differences in SUVmax, SUVratio and MTV were observed in relation to tumour grade (p < 0.001). IDH1 mutation was found in 49 patients, 1p/19q codeletion in 58 patients and MGMT promoter methylation in 74 patients. SUVmax and SUVratio were significantly inversely correlated with the presence of IDH1 mutation (p < 0.001). Using the 2016 WHO classification, SUVmax and SUVratio were significantly higher in patients with primary glioblastoma (IDH1-negative) than in those with other diffuse gliomas (p < 0.001). Relapse or progression was documented in 48 patients (median PFS 8.7 months). Cox regression analysis showed that SUVmax and SUVratio, tumour grade, tumour type on 2016 WHO classification, IDH1 mutation status, 1p/19q codeletion and MGMT promoter methylation were significantly associated with PFS. None of these factors was found to be an independent prognostic factor in multivariate analysis.
C-METH PET parameters are significantly correlated with histological grade and IDH1 mutation status in patients with glioma. Grade, pathological classification, molecular biomarkers, SUVmax and SUVratio were prognostic factors for PFS in this cohort of patients. The trial was registered with ClinicalTrials.gov (registration: NCT02518061).
我们评估了接受手术的幕上胶质瘤患者的¹¹C-蛋氨酸PET（¹¹C-METH PET）检查结果与分子生物标志物之间的关系。
分析了2012年3月至2015年1月期间连续转诊至我院进行肿瘤切除且术前行¹¹C-METH PET检查的109例经病理证实的胶质瘤患者（64例男性，45例女性；中位年龄43岁）。¹¹C-METH PET图像的半定量评估包括最大标准摄取值（SUVmax）、感兴趣区与正常脑SUV比值（SUVratio）和代谢肿瘤体积（MTV）。影像学检查结果与无进展生存期（PFS）方面的疾病转归相关，并与其他临床生物学数据进行比较，包括异柠檬酸脱氢酶1（IDH1）突变状态、1p/19q共缺失和O⁶-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化。对患者进行了平均16.7个月（中位时间13个月）的监测。
在所有患者中，¹¹C-METH PET均发现了肿瘤。观察到SUVmax、SUVratio和MTV在肿瘤分级方面存在显著差异（p < 0.001）。49例患者发现IDH1突变，58例患者发现1p/19q共缺失，74例患者发现MGMT启动子甲基化。SUVmax和SUVratio与IDH1突变的存在显著负相关（p < 0.001）。根据2016年世界卫生组织（WHO）分类，原发性胶质母细胞瘤（IDH1阴性）患者的SUVmax和SUVratio显著高于其他弥漫性胶质瘤患者（p < 0.001）。48例患者记录到复发或进展（中位PFS 8.7个月）。Cox回归分析显示，SUVmax和SUVratio、肿瘤分级、2016年WHO分类的肿瘤类型、IDH1突变状态、1p/19q共缺失和MGMT启动子甲基化与PFS显著相关。在多变量分析中，这些因素均未被发现是独立的预后因素。
¹¹C-METH PET参数与胶质瘤患者的组织学分级和IDH1突变状态显著相关。分级、病理分类、分子生物标志物、SUVmax和SUVratio是该组患者PFS的预后因素。该试验已在ClinicalTrials.gov注册（注册号：NCT02518061）。
