Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China.
Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Cancer Imaging. 2024 Jun 11;24(1):72. doi: 10.1186/s40644-024-00718-3.
Neuroblastoma (NB) is a highly heterogeneous tumor, and more than half of newly diagnosed NB are associated with extensive metastases. Accurately characterizing the heterogeneity of whole-body tumor lesions remains clinical challenge. This study aims to quantify whole-tumoral metabolic heterogeneity (WMH) derived from whole-body tumor lesions, and investigate the prognostic value of WMH in NB.
We retrospectively enrolled 95 newly diagnosed pediatric NB patients in our department. Traditional semi-quantitative PET/CT parameters including the maximum standardized uptake value (SUVmax), the mean standardized uptake value (SUVmean), the peak standardized uptake value (SUVpeak), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured. These PET/CT parameters were expressed as PSUVmax, PSUVmean, PSUVpeak, PMTV, PTLG for primary tumor, WSUVmax, WSUVmean, WSUVpeak, WMTV, WTLG for whole-body tumor lesions. The metabolic heterogeneity was quantified using the areas under the curve of the cumulative SUV-volume histogram index (AUC-CSH index). Intra-tumoral metabolic heterogeneity (IMH) and WMH were extracted from primary tumor and whole-body tumor lesions, respectively. The outcome endpoints were overall survival (OS) and progression-free survival (PFS). Survival analysis was performed utilizing the univariate and multivariate Cox proportional hazards regression. The optimal cut-off values for metabolic parameters were obtained by receiver operating characteristic curve (ROC).
During follow up, 27 (28.4%) patients died, 21 (22.1%) patients relapsed and 47 (49.5%) patients remained progression-free survival, with a median follow-up of 35.0 months. In survival analysis, WMTV and WTLG were independent indicators of PFS, and WMH was an independent risk factor of PFS and OS. However, IMH only showed association with PFS and OS. In addition to metabolic parameters, the International Neuroblastoma Staging System (INSS) was identified as an independent risk factor for PFS, and neuron-specific enolase (NSE) served as an independent predictor of OS.
WMH was an independent risk factor for PFS and OS, suggesting its potential as a novel prognostic marker for newly diagnosed NB patients.
神经母细胞瘤（NB）是一种高度异质性的肿瘤，超过一半的新诊断 NB 伴有广泛的转移。准确描述全身肿瘤病变的异质性仍然是临床挑战。本研究旨在量化全身肿瘤病变的整体肿瘤代谢异质性（WMH），并探讨 WMH 在 NB 中的预后价值。
我们回顾性纳入了我院 95 例新诊断的小儿 NB 患者。测量了传统的半定量 PET/CT 参数，包括最大标准化摄取值（SUVmax）、平均标准化摄取值（SUVmean）、峰值标准化摄取值（SUVpeak）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。这些 PET/CT 参数表示为原发肿瘤的 PSUVmax、PSUVmean、PSUVpeak、PMTV、PTLG，全身肿瘤病变的 WSUVmax、WSUVmean、WSUVpeak、WMTV、WTLG。使用累积 SUV-体积直方图指数（AUC-CSH 指数）的曲线下面积来量化代谢异质性。从原发肿瘤和全身肿瘤病变中分别提取肿瘤内代谢异质性（IMH）和 WMH。结局终点是总生存（OS）和无进展生存（PFS）。利用单变量和多变量 Cox 比例风险回归进行生存分析。通过受试者工作特征曲线（ROC）获得代谢参数的最佳截断值。
在随访期间，27 例（28.4%）患者死亡，21 例（22.1%）患者复发，47 例（49.5%）患者无进展生存，中位随访时间为 35.0 个月。在生存分析中，WMTV 和 WTLG 是 PFS 的独立指标，WMH 是 PFS 和 OS 的独立危险因素。然而，IMH 仅与 PFS 和 OS 相关。除代谢参数外，国际神经母细胞瘤分期系统（INSS）也是 PFS 的独立危险因素，神经元特异性烯醇化酶（NSE）是 OS 的独立预测因子。
WMH 是 PFS 和 OS 的独立危险因素，表明其作为新诊断 NB 患者的一种新的预后标志物具有潜在价值。
