视觉和半定量 11C-蛋氨酸 PET：新诊断和未经治疗的脑胶质瘤患者生存的独立预后因素。
Visual and semiquantitative 11C-methionine PET: an independent prognostic factor for survival of newly diagnosed and treatment-naïve gliomas.
机构信息
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Institute of Neurology, Medical University of Vienna, Vienna, Austria.
出版信息
Neuro Oncol. 2018 Feb 19;20(3):411-419. doi: 10.1093/neuonc/nox177.
BACKGROUND
Few data exist regarding the prognostic value of L-[S-methyl-11C]methionine (MET) PET for treatment-naïve gliomas.
METHODS
A total of 160 glioma patients (89 men, 71 women; mean age: 45, range 18-84 y) underwent a MET PET prior to any therapy. The PET scans were evaluated visually and semiquantitatively by tumor-to-background (T/N) ratio thresholds chosen by analysis of receiver operating characteristics. Additionally, isocitrate dehydrogenase 1-R132H (IDH1-R132H) immunohistochemistry was performed. Survival analysis was done using Kaplan-Meier estimates and the Cox proportional hazards model.
RESULTS
Significantly shorter mean survival times (7.2 vs 8.6 y; P = 0.024) were seen in patients with amino acid avid gliomas (n = 137) compared with visually negative tumors (n = 33) in MET PET. T/N ratio thresholds of 2.1 and 3.5 were significantly associated with survival (10.3 vs 7 vs 4.3 y; P < 0.001). Mean survival differed significantly using the median T/N ratio of 2.4 as cutoff, independent of histopathology (P < 0.01; mean survival: 10.2 ± 0.8 y vs 5.5 ± 0.6 y). In the subgroup of 142 glioma patients characterized by IDH1-R132H status, METT/N ratio demonstrated a significant prognostic impact in IDH1-R132H wildtype astrocytomas and glioblastoma (P = 0.001). Additionally, multivariate testing revealed semiquantitative MET PET as an independent prognostic parameter for treatment-naïve glioma patients without (P = 0.031) and with IDH1-R132H characterization of gliomas (P = 0.024; odds ratio 1.57).
CONCLUSION
This retrospective analysis demonstrates the value of MET PET as a prognostic parameter on survival in treatment-naïve glioma patients.
背景
关于治疗初发脑胶质瘤时 L-[S-甲基-11C]蛋氨酸（MET）正电子发射断层扫描（PET）的预后价值，目前仅有少量数据。
方法
共有 160 例脑胶质瘤患者（89 名男性，71 名女性；平均年龄：45 岁，范围 18-84 岁）在任何治疗前均进行了 MET PET 检查。通过分析接受者操作特征选择肿瘤与背景（T/N）比值阈值来对 PET 扫描进行视觉和半定量评估。此外，还进行了异柠檬酸脱氢酶 1-R132H（IDH1-R132H）免疫组化检查。使用 Kaplan-Meier 估计和 Cox 比例风险模型进行生存分析。
结果
与 MET PET 视觉阴性肿瘤（n = 33）相比，氨基酸活性胶质瘤（n = 137）患者的平均生存时间显著缩短（7.2 年比 8.6 年；P = 0.024）。T/N 比值阈值为 2.1 和 3.5 与生存显著相关（10.3 年比 7 年比 4.3 年；P < 0.001）。使用中位数 T/N 比值 2.4 作为截止值时，生存差异有统计学意义，与组织病理学无关（P < 0.01；平均生存时间：10.2 ± 0.8 年比 5.5 ± 0.6 年）。在 142 例 IDH1-R132H 状态特征明确的脑胶质瘤患者亚组中，METT/N 比值在 IDH1-R132H 野生型星形细胞瘤和胶质母细胞瘤中具有显著的预后影响（P = 0.001）。此外，多变量检验显示，在未经 IDH1-R132H 特征化和经 IDH1-R132H 特征化的脑胶质瘤患者中，半定量 MET PET 是独立的预后参数（P = 0.031 和 P = 0.024；优势比 1.57）。
结论
这项回顾性分析表明，MET PET 作为治疗初发脑胶质瘤患者生存的预后参数具有价值。
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