Department of Pediatric Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
Clin Transl Oncol. 2023 Jun;25(6):1710-1718. doi: 10.1007/s12094-022-03068-3. Epub 2023 Jan 14.
The chemosensitivity of osteosarcoma patients to MTX is closely related to prognosis. There is currently a lack of advance prediction methods for MTX sensitivity.
We proposed novel peri-osteosarcoma fat parameters based on computed tomography (CT) to evaluate the chemotherapy response preoperatively and calculate the correlation between image characteristics and methotrexate (MTX) blood concentration and systemic inflammation.
Pediatric patients with osteosarcoma (OS) who were treated with high-dose MTX were retrospectively studied and grouped according to postoperative Huvos classification. Clinical data were collected and reviewed. Image characteristics including peri-osteosarcoma fat volume and fat attenuation index were measured using the threshold method based on CT images. Statistical significance, correlation and prediction performance were performed.
Eighteen patients (good response (GR) group/poor response (PR) group: 10/8) was enrolled. MTX peak value at 6 h differed significantly between the two groups which was significantly higher in GR group (745.1 μmol/L vs 529.0 μmol/L p = 0.001). Peri-osteosarcoma fat attenuation index was significantly lower in GR group compared with that in PR group (- 104.90 vs. - 97.19, p < 0.0001). MTX blood concentration at 6 h negatively correlated with peri-osteosarcoma fat attenuation index (R = - 0.519, p = 0.027). In addition, 6 h MTX blood concentration (OR 0.974; 95% CI 0.951-0.998, p = 0.037) and FAI (OR 2.108; 95% CI 1.047-4.243, p = 0.037) were, respectively, independently related to good response to chemotherapy. The prediction performance on chemotherapy response of peri-osteosarcoma fat attenuation index and 6 h MTX blood concentration were both good with the comparable area under the ROC curve (0.950, 95% CI 0.856-1.000 and 0.963, 95% CI 0.878-1.00).
Peri-osteosarcoma fat parameters based on CT were associated with the chemotherapy response and the MTX blood concentration, but not with the systemic inflammation. Combined with the requirement of current clinical practice, peri-osteosarcoma fat parameters may have the potential to be valuable image characteristics for monitoring chemotherapy response in OS pediatric patients.
骨肉瘤患者对 MTX 的化疗敏感性与预后密切相关。目前缺乏 MTX 敏感性的预测方法。
本研究旨在基于 CT 提出新的骨旁骨肉瘤脂肪参数，以术前评估化疗反应，并计算图像特征与甲氨蝶呤（MTX）血药浓度和全身炎症之间的相关性。
回顾性分析了接受大剂量 MTX 治疗的骨肉瘤（OS）患儿的临床资料，根据术后 Huvos 分级进行分组。采用 CT 图像阈值法测量骨旁脂肪体积和脂肪衰减指数等图像特征。进行统计学意义、相关性和预测性能分析。
本研究共纳入 18 例患者（良好反应（GR）组/不良反应（PR）组：10/8）。两组患者术后 6 h MTX 峰值差异有统计学意义，GR 组明显高于 PR 组（745.1 μmol/L 比 529.0 μmol/L，p=0.001）。GR 组的骨旁脂肪衰减指数明显低于 PR 组（-104.90 比-97.19，p<0.0001）。6 h MTX 血药浓度与骨旁脂肪衰减指数呈负相关（R=-0.519，p=0.027）。此外，6 h MTX 血药浓度（OR 0.974；95%CI 0.951-0.998，p=0.037）和 FAI（OR 2.108；95%CI 1.047-4.243，p=0.037）与化疗反应良好呈独立相关。骨旁脂肪衰减指数和 6 h MTX 血药浓度对化疗反应的预测性能均较好，ROC 曲线下面积相似（0.950、95%CI 0.856-1.000 和 0.963、95%CI 0.878-1.00）。
基于 CT 的骨旁脂肪参数与化疗反应和 MTX 血药浓度相关，与全身炎症无关。结合当前临床实践的要求，骨旁脂肪参数可能具有监测骨肉瘤患儿化疗反应的潜在价值。
