Bailly Clement, Leforestier Rodolphe, Campion Loic, Thebaud Estelle, Moreau Anne, Kraeber-Bodere Francoise, Carlier Thomas, Bodet-Milin Caroline
Nuclear Medicine Department, University Hospital, Nantes, France.
Nantes-Angers Cancer Research Center CRCNA, University of Nantes, INSERM UMR892, CNRS-UMR6299, Nantes, France.
PLoS One. 2017 Aug 25;12(8):e0183841. doi: 10.1371/journal.pone.0183841. eCollection 2017.
The objective of this retrospective work was to evaluate the prognostic value on histological response and survival of quantitative indices derived from FDG-PET performed before and after chemotherapy (CHT), in a homogeneous pediatric Ewing sarcoma (EWS) and Osteosarcoma (OST) population.
Thirty-one patients with EWS and 31 with OST were included. All patients were treated with neoadjuvant CHT, and underwent surgery for local control. All patients had FDG-PET at diagnosis and after CHT, prior to surgery. Several parameters were evaluated: SUVmax, SUVpeak, SUVmean, metabolic tumor volume, total lesion glycolysis, 7 textural features and 3 shape features (SF). The segmentation was performed using an adaptive approach. Results were compared to histopathological regression of the resected tumor and to clinical follow-up for survival evaluation.
For EWS, univariate analysis did not highlight any prognostic value on histological response, or survival regardless of all the considered metrics. For OST, only one of the SF, namely elongation, was significantly associated with PFS and OS on both univariate and multivariate analysis (PFS: p = 0.019, HR = 5.583; OS: p = 0.0062, HR = 7.113).
Only elongation determined on initial FDG-PET has a potential interest as a prognostic factor of PFS and OS in pediatric OST patients. Unlike recent studies of the literature realized in adult population, all the metrics reveal limited additional prognostic value in pediatric EWS patients. This seems to reinforce the question of whether children experience different subtypes of the same pathologies than older patients, with different outcomes.
这项回顾性研究的目的是评估在一组同质的儿童尤因肉瘤（EWS）和骨肉瘤（OST）患者中，化疗（CHT）前后进行的氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）得出的定量指标对组织学反应和生存的预后价值。
纳入31例EWS患者和31例OST患者。所有患者均接受新辅助CHT治疗，并接受手术以进行局部控制。所有患者在诊断时、CHT后及手术前均进行了FDG-PET检查。评估了几个参数：最大标准摄取值（SUVmax）、峰值标准摄取值（SUVpeak）、平均标准摄取值（SUVmean）、代谢肿瘤体积、总病变糖酵解、7种纹理特征和3种形状特征（SF）。使用自适应方法进行分割。将结果与切除肿瘤的组织病理学退缩情况以及生存评估的临床随访结果进行比较。
对于EWS，单因素分析未发现所有考虑指标对组织学反应或生存有任何预后价值。对于OST，单因素和多因素分析均显示，只有一种SF，即伸长率，与无进展生存期（PFS）和总生存期（OS）显著相关（PFS：p = 0.019，风险比[HR] = 5.583；OS：p = 0.0062，HR = 7.113）。
仅初始FDG-PET测定的伸长率作为儿童OST患者PFS和OS的预后因素具有潜在意义。与近期在成人中进行的文献研究不同，所有指标在儿童EWS患者中显示出有限的额外预后价值。这似乎强化了一个问题，即儿童与老年患者是否经历相同病理的不同亚型，且预后不同。
