Semi-Quantitative Calculations of Primary Tumor Metabolic Activity Using F-18 FDG PET/CT as a Predictor of Survival in 92 Patients With High-Grade Bone or Soft Tissue Sarcoma

Abstract

To assess the prognostic value of primary tumor metabolic activity in patients with high-grade bone sarcomas (BS) or soft tissue sarcomas (STS) using F-18 FDG PET/CT.A single-site, retrospective study including 92 patients with high-grade BS or STS. Pretreatment F-18 FDG PET/CT scan was performed. Clinical data were registered. Accuracy of maximum standardized uptake value of primary tumor (SUVmax) and tumor-to-background (T/B) uptake ratio as prognostic variables and identification of cut-off values to group patients were determined. Kaplan–Meier survival estimates and log-rank test were used to compare survival distributions. Prognostic variables were assessed using Cox proportional hazards regression analysis.Forty-one of 92 patients died during follow-up (45%). Average survival was 6.5 years (95% CI 5.8–7.3 years) and probability of 5-year survival was 52%. Accuracy of SUVmax and T/B uptake ratio as prognostic variables in all patients and during subgroup analysis of patients with STS was significant. No significant results for AUCs were registered in patients with BS. Surgery was independently prognostic for survival throughout multivariate regression analysis of all patients (P = .001, HR 3.84) and subgroup analysis (BS: P = .02, HR 11.62; STS: P = .005, HR 4.13). SUVmax was significant as prognostic variable in all patients (P = .02, HR 3.66) and in patients with STS (P = .007, HR 3.75). No significant results were demonstrated for T/B uptake ratio.Estimation of primary tumor metabolic activity with pretherapeutic SUVmax using F-18 FDG PET/CT demonstrates independent properties beyond histologic grading for prediction of survival in patients with high-grade STS, but not with high-grade BS.

Volume-Based F-18 FDG PET/CT Imaging Markers Provide Supplemental Prognostic Information to Histologic Grading in Patients With High-Grade Bone or Soft Tissue Sarcoma

“…We have previously reported the shortcomings of the prognostic use of SUV max and tumor-to-background uptake ratio in the same study cohort, especially in subgroup analysis of patients with high-grade BS. 27 The volume-based F-18 FDG PET imaging markers MTV and TLG attempt to overcome the limitations of SUV max , by including several important prognostic tumor characteristics, such as heterogeneity, size, and burden; that is, an inclusion of the total volume and total activity of metabolically active tumor cells. This theoretical advantage has been verified by several studies reporting significant prognostic properties in terms of prediction of treatment response and survival in a diversity of solid tumors.…”

“…A single-site, retrospective study from July 1st 2002 to December 31st 2012 including 92 consecutive patients, with clinical characteristics and study design as previously reported 27 (47 men; 45 women; median age 49.8 [11.2–86.3] years; Table 1 ). The patients were referred for further evaluation and/or surgical treatment and were included in the study according to the following criteria: first, histologically verified high-grade BS (N = 37) or STS (N = 55) according to either the French Federation of Cancer Centers Sarcoma Group (FNCLCC) grading system (STS) 28 or the grading recommendations of the College of American Pathologists (BS), 29 second, no previous history of malignancy, third, underwent an on-site pre-operative 18 F-FDG PET/CT scan for staging, and fourth, a minimum follow-up period of 1 year for survived patients.…”

Prognostic significance of maximum standardized uptake value on 18 F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in bone sarcomas

“…Recent studies supported that baseline SUV max using 18 FDG-PET/CT demonstrates independent properties beyond histologic grading for prediction of survival. Andersen et al [11] reported a cut-off point of 9, whereas Hwang et al [7] and Skamene et al [12] revealed cut-off points of 5.8 and 10.3, respectively. In our study, findings were consistent with the literature stating that higher SUV max has significantly poor survival outcomes in sarcoma patients.…”

A risk‐based approach to identifying oligometastatic disease on imaging

“…Angiogenic features, maximum standardised uptake value on FDG-PET, apparent diffusion coefficient on MRI are all linked to tumour grade and metastatic risk, [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] but no evidence for their use in distinguishing OM from PM…”