Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Oncology Department, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Cancer Imaging. 2022 Jul 5;22(1):32. doi: 10.1186/s40644-022-00472-4.
Neuroblastoma (NB) is the most common tumour in children younger than 5 years old and notable for highly heterogeneous. Our aim was to quantify the intra-tumoural metabolic heterogeneity of primary tumour lesions by using F-FDG PET/CT and evaluate the prognostic value of intra-tumoural metabolic heterogeneity in NB patients.
We retrospectively enrolled 38 pretreatment NB patients in our study. F-FDG PET/CT images were reviewed and analyzed using 3D slicer software. The semi-quantitative metabolic parameters of primary tumour were measured, including the maximum standard uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG). The areas under the curve of cumulative SUV-volume histogram index (AUC-CSH index) was used to quantify intra-tumoural metabolic heterogeneity. The median follow-up was 21.3 months (range 3.6 - 33.4 months). The outcome endpoint was event-free survival (EFS), including progression-free survival and overall survival. Survival analysis was performed using Cox regression models and Kaplan Meier survival plots.
In all 38 newly diagnosed NB patients, 2 patients died, and 17 patients experienced a relapse. The AUC-CSH (r=0.630, P<0.001) showed moderate correlation with the AUC-CSH. In univariate analysis, chromosome 11q deletion (P=0.033), Children's Oncology Group (COG) risk grouping (P=0.009), bone marrow involvement (BMI, P=0.015), and AUC-CSH (P=0.007) were associated with EFS. The AUC-CSH (P=0.036) and BMI (P=0.045) remained significant in multivariate analysis. The Kaplan Meier survival analyses demonstrated that patients with higher intra-tumoural metabolic heterogeneity and BMI had worse outcomes (log-rank P=0.002).
The intra-tumoural metabolic heterogeneity of primary lesions in NB was an independent prognostic factor for EFS. The combined predictive effect of intra-tumoural metabolic heterogeneity and BMI provided prognostic survival information in NB patients.
神经母细胞瘤（NB）是 5 岁以下儿童中最常见的肿瘤，其特点是高度异质性。我们的目的是通过使用 F-FDG PET/CT 定量测定原发肿瘤病变的肿瘤内代谢异质性，并评估 NB 患者肿瘤内代谢异质性的预后价值。
我们回顾性地纳入了 38 例 NB 患者的研究。使用 3D slicer 软件对 F-FDG PET/CT 图像进行了回顾性分析和评估。测量了原发肿瘤的半定量代谢参数，包括最大标准摄取值（SUVmax）、代谢肿瘤体积（MTV）和总肿瘤糖酵解（TLG）。累积 SUV 体积直方图指数的曲线下面积（AUC-CSH 指数）用于量化肿瘤内代谢异质性。中位随访时间为 21.3 个月（范围 3.6-33.4 个月）。结局终点为无事件生存（EFS），包括无进展生存和总生存。使用 Cox 回归模型和 Kaplan-Meier 生存图进行生存分析。
在所有 38 例新诊断的 NB 患者中，2 例死亡，17 例复发。AUC-CSH（r=0.630，P<0.001）与 AUC-CSH 呈中度相关性。单因素分析显示，11q 染色体缺失（P=0.033）、儿童肿瘤协作组（COG）风险分组（P=0.009）、骨髓受累（BMI，P=0.015）和 AUC-CSH（P=0.007）与 EFS 相关。多因素分析中，AUC-CSH（P=0.036）和 BMI（P=0.045）仍然具有显著性。Kaplan-Meier 生存分析表明，肿瘤内代谢异质性和 BMI 较高的患者预后较差（对数秩 P=0.002）。
NB 原发肿瘤病变的肿瘤内代谢异质性是 EFS 的独立预后因素。肿瘤内代谢异质性和 BMI 的联合预测作用为 NB 患者提供了预后生存信息。
