Department of Neurosurgery, University of Munich, Munich, Germany.
German Cancer Consortium, partner site Munich, Germany.
Neuro Oncol. 2019 Feb 14;21(2):274-284. doi: 10.1093/neuonc/noy098.
We aimed to elucidate the place of dynamic O-(2-[18F]-fluoroethyl)-L-tyrosine (18F-FET) PET in prognostic models of gadolinium (Gd)-negative gliomas.
In 98 patients with Gd-negative gliomas undergoing 18F-FET PET guided biopsy, time activity curves (TACs) of each tumor were qualitatively categorized as either increasing or decreasing. Additionally, post-hoc quantitative analyses were done using minimal time-to-peak (TTPmin) measurements. Prognostic factors were obtained from multivariate hazards models. The fit of the biospecimen- and imaging-derived models was compared.
A homogeneous increasing, mixed, and homogeneous decreasing TAC pattern was seen in 51, 19, and 28 tumors, respectively. Mixed TAC tumors exhibited both increasing and decreasing TACs. Corresponding adjusted 5-year survival was 85%, 47%, and 19%, respectively (P < 0.001). Qualitative and quantitative TAC measurements were highly intercorrelated (P < 0.0001). TTPmin was longest (shortest) in the homogeneous increasing (decreasing) TAC group and in between in the mixed TAC group. TTPmin was longer in isocitrate dehydrogenase (IDH)-mutant tumors (P < 0.001). Outcome was similarly precisely predicted by biospecimen- and imaging-derived models. In the biospecimen model, World Health Organization (WHO) grade (P < 0.0001) and IDH status (P < 0.001) were predictors for survival. Outcome of homogeneous increasing (homogeneous decreasing) TAC tumors was nearly identical, with both TTPmin > 25 min (TTPmin ≤ 12.5 min) tumors and IDH-mutant grade II (IDH-wildtype) gliomas. Outcome of mixed TAC tumors matched that of both intermediate TTPmin (>12.5 min and ≤25 min) and IDH-mutant, grade III gliomas. Each of the 3 prognostic clusters differed significantly from the other ones of the respective models (P < 0.001).
TAC measurements constitute a powerful biomarker independent from tumor grade and IDH status.
我们旨在阐明动态 O-(2-[18F]-氟乙基)-L-酪氨酸（18F-FET）PET 在钆（Gd）阴性胶质瘤预后模型中的地位。
在 98 例接受 18F-FET PET 引导活检的 Gd 阴性胶质瘤患者中，对每个肿瘤的时间活性曲线（TAC）进行定性分类为递增或递减。此外，使用最小达峰时间（TTPmin）测量值进行事后定量分析。从多变量风险模型中获得预后因素。比较了生物样本和影像学衍生模型的拟合情况。
51、19 和 28 例肿瘤分别表现为均匀递增、混合和均匀递减 TAC 模式。混合 TAC 肿瘤表现为递增和递减 TAC。相应的调整后 5 年生存率分别为 85%、47%和 19%（P<0.001）。定性和定量 TAC 测量高度相关（P<0.0001）。TTPmin 在均匀递增（递减）TAC 组中最长（最短），在混合 TAC 组中介于两者之间。异柠檬酸脱氢酶（IDH）突变型肿瘤的 TTPmin 较长（P<0.001）。生物样本和影像学衍生模型同样精确地预测了结果。在生物样本模型中，世界卫生组织（WHO）分级（P<0.0001）和 IDH 状态（P<0.001）是生存的预测因素。均匀递增（均匀递减）TAC 肿瘤的结果几乎相同，TTPmin>25 min（TTPmin≤12.5 min）肿瘤和 IDH 突变型 II 级（IDH-野生型）胶质瘤。混合 TAC 肿瘤的结果与中间 TTPmin（>12.5 min 和≤25 min）和 IDH 突变型、III 级胶质瘤的结果相匹配。每个预后聚类与各自模型的其他聚类有显著差异（P<0.001）。
TAC 测量是一种独立于肿瘤分级和 IDH 状态的强大生物标志物。
