Prognostic Stratification of Standard Responders to Neoadjuvant Chemotherapy in Patients with Osteosarcoma Using <sup>18</sup>F-FDG PET/CT Imaging.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 41220604.
- Also identified by DOI 10.2106/JBJS.OA.25.00133 and PMC identifier 12599647.
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Abstract
We aimed to identify a new biomarker using <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) positron emission tomography (PET)/computed tomography (CT) parameters to identify osteosarcoma patients with standard response after neoadjuvant chemotherapy (NAC). Fifty-four patients with conventional osteosarcoma (age ≤39 years) were included in this study. All patients underwent <sup>18</sup>F-FDG PET/CT before (PET1) and after NAC (PET2). We measured PET parameters, including maximum, average, and peak standardized uptake value (SUVmax, SUVave, and SUVpeak); metabolic tumor volume (MTV); and total lesion glycolysis (TLG). Their changes (ΔPET = PET2/PET1) were also examined. The patients were classified into 4 groups based on the histological tumor necrosis rate (TNR): G0 (<50%), G1 (50 to < 90%), G2 (90 to < 100%), and G3 (100%). G0 and G1 patients were enrolled in the standard responder (SR) group (n = 35), while G2 and G3 patients were enrolled in the good responder (GR) group (n = 19). We examined the correlation between changes in each <sup>18</sup>F-FDG PET/CT parameter and TNR as well as overall survival (OS) and progression-free survival (PFS) among the 4 groups. In the SR group, the median value of ΔSUVmax was calculated and correlated with prognostic stratification. The changes in each PET parameter were correlated with TNR, with SUVpeak showing the strongest correlation. Moreover, in the SR group, there were no differences in OS or PFS between G0 and G1. Patients in the SR group were stratified into 2 groups according to the median ΔSUVmax value (0.62). Patients with ΔSUVmax < 0.62 had significantly better OS (P < 0.01) and PFS (P = 0.02) in comparison with patients with ΔSUVmax ≥ 0.62. In multivariate analyses, ΔSUVmax showed a correlation with OS in the SR group. This study revealed that ΔSUVmax may confirm the preoperative stratification of the prognosis be a predictive biomarker for patients in the SR group. Moreover, the preoperative identification of patients with a worse prognosis in the SR group has a significant impact on improving the clinical outcomes of patients with osteosarcoma. Prognostic studies, Level III. See Instructions for Authors for a complete description of levels of evidence.