To investigate whether tumor texture features derived from pretreatment with 18F-fluorodeoxyglucose positron emission tomography (FDG PET) can predict histological response or event-free survival (EFS) in patients with localized osteosarcoma of the extremities treated by neoadjuvant chemotherapy (NAC).
We retrospectively reviewed 35 patients with American Joint Committee on Cancer stage II extremity osteosarcoma treated with NAC and surgery. Primary tumor traditional parameters and texture features were measured for all 18F-FDG PET images prior to treatment. After surgery, histological responses to NAC were evaluated on the postsurgical specimens. A receiver operating characteristic curve (ROC) was constructed to evaluate the optimal predictive performance among the various indices. EFS was calculated using the Kaplan-Meier method and prognostic significance was assessed by Cox proportional hazards analysis.
Pathologic examination revealed 16 (45.71%) good responders and 19 (54.29%) poor responders. Although both the texture features (least axis, dependence nonuniformity, run length nonuniformity, and size zone nonuniformity) and metabolic tumor volume (MTV) can predict tumor response of osteosarcoma to NAC, the traditional indicator MTV has the best performance according to ROC curve analysis (area under the curve = 0.918, p < 0.0001). In multivariate analysis, MTV (p < 0.0001), histological response (p = 0.0003), and texture feature of coarsenessNGTDM (neighboring gray tone difference matrix) (p = 0.005) were independently associated with EFS.
Intratumoral heterogeneity of baseline 18F-FDG uptake measured by PET texture analysis can predict tumor response and EFS of patients with extremity osteosarcoma treated by NAC, but the conventional parameter MTV provides better predictive power and is a strong independent prognostic factor.
• The baseline 18 F-FDG PET tumor texture features can predict tumor NAC response for patients with osteosarcoma.
• Coarseness NGTDM is a new and independent prognostic factor for osteosarcoma.
• MTV provides the best predictive power and is a strong independent prognostic factor for patients with osteosarcoma.
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American Joint Committee on Cancer
Receiver operating characteristic (ROC) curves
Dependence nonuniformity normalized
Gray level co-occurrence matrix
Gray level dependence matrix
Gray level nonuniformity
Gray level run length matrix
Gray level size zone matrix
Gray level variance
High gray level emphasis
Large dependence emphasis
Low gray level emphasis
Metabolic tumor volume
Neighboring gray tone difference matrix
Positron emission tomography-computed tomography
Run length nonuniformity
Receiver operating characteristic
Maximum standardized uptake value
Mean standardized uptake value
Surface volume ratio
Size zone nonuniformity
Total lesion glycolysis
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The scientific guarantor of this publication is Professor Quanyong Luo, email: firstname.lastname@example.org.
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Statistics and biometry
Hongjun Song and Qian Wang have significant statistical expertise and no complex statistical methods were necessary for this paper.
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Song, H., Jiao, Y., Wei, W. et al. Can pretreatment 18F-FDG PET tumor texture features predict the outcomes of osteosarcoma treated by neoadjuvant chemotherapy?. Eur Radiol 29, 3945–3954 (2019) doi:10.1007/s00330-019-06074-2
- Positron emission tomography-computed tomography
- Neoadjuvant therapy