Ninatti Gaia, Pini Cristiano, Bono Beatrice Claudia, Gelardi Fabrizia, Antunovic Lidija, Fernandes Bethania, Sollini Martina, Landoni Claudio, Chiti Arturo, Pessina Federico
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
J Neurooncol. 2023 Sep;164(2):473-481. doi: 10.1007/s11060-023-04438-9. Epub 2023 Sep 11.
IDH-wildtype (IDH-wt) diffuse gliomas with histological features of lower-grade gliomas (LGGs) are rare and heterogeneous primary brain tumours. [C]Methionine (MET) positron emission tomography (PET) is commonly used to evaluate glial neoplasms at diagnosis. The present study aimed to assess the prognostic value of MET PET in newly diagnosed, treatment naïve IDH-wt gliomas with histological features of LGGs.
Patients with a histological diagnosis of IDH-wt LGG who underwent preoperative (< 100 days) MET PET/CT and surgery were retrospectively included. Qualitative and semi-quantitative analyses of MET PET images were performed. Progression-free survival (PFS) and overall survival (OS) were analysed by Kaplan-Meier curves. Cox proportional-hazards regression was used to test the association of imaging and clinical data to PFS and OS.
We included 48 patients (M:F = 25:23; median age 55). 39 lesions were positive and 9 negative at MET PET. Positive MET PET was significantly associated with shorter median PFS (15.7 months vs. not reached, p = 0.0146) and OS time (32.6 months vs. not reached, p = 0.0253). Incomplete surgical resection and higher TBR values were independent predictors of shorter PFS on multivariate analysis (p < 0.001 for both). Higher tumour grade and incomplete surgical resection were independent predictors of OS at multivariate analysis (p = 0.027 and p = 0.01, respectively).
MET PET is useful for the prognostic stratification of patients with IDH-wt glial neoplasms with histological LGGs features. Considering their huge biological heterogeneity, the combination of MET PET and molecular analyses may help to improve the prognostic accuracy in these diffuse gliomas subset and influence therapeutic choices accordingly.
具有低级别胶质瘤（LGG）组织学特征的异柠檬酸脱氢酶野生型（IDH-wt）弥漫性胶质瘤是罕见且异质性的原发性脑肿瘤。甲硫氨酸（MET）正电子发射断层扫描（PET）通常用于在诊断时评估胶质肿瘤。本研究旨在评估MET PET对新诊断的、未经治疗的具有LGG组织学特征的IDH-wt胶质瘤的预后价值。
回顾性纳入组织学诊断为IDH-wt LGG且术前行（<100天）MET PET/CT及手术的患者。对MET PET图像进行定性和半定量分析。采用Kaplan-Meier曲线分析无进展生存期（PFS）和总生存期（OS）。使用Cox比例风险回归检验影像和临床数据与PFS及OS的相关性。
我们纳入了48例患者（男：女 = 25：23；中位年龄55岁）。MET PET检查中39个病灶为阳性，9个为阴性。MET PET阳性与较短的中位PFS（15.7个月对未达到，p = 0.0146）和OS时间（32.6个月对未达到，p = 0.0253）显著相关。多因素分析显示，手术切除不完全和较高的肿瘤标准化摄取值（TBR）是PFS较短的独立预测因素（两者p均<0.001）。多因素分析显示，较高的肿瘤分级和手术切除不完全是OS的独立预测因素（分别为p = 0.027和p = 0.01）。
MET PET对具有LGG组织学特征的IDH-wt胶质肿瘤患者的预后分层有用。鉴于其巨大的生物学异质性，MET PET与分子分析相结合可能有助于提高这些弥漫性胶质瘤亚组的预后准确性，并相应地影响治疗选择。
