Abstract
Objectives
To evaluate the association between metabolic response on 18F-FDG PET/CT and long-term survival in children with neuroblastoma (NB).
Methods
A total of 39 consecutive children with newly diagnosed stage 4 NB undergoing both 18F-FDG PET/CT imaging at baseline and after chemotherapy were retrospectively analyzed. The associations between metabolic parameters, including SUVmax of the lesion with the most intense 18F-FDG uptake at baseline (SUVb), after chemotherapy (SUVe), and the percentage change between SUVb and SUVe, and long-term survival were evaluated.
Results
With a median follow-up of 56 months, 22 patients who had achieved complete resolution on PET (no residual 18F-FDG uptake higher than the surrounding backgrounds) after chemotherapy had superior 5-year overall survival (OS) (73.6% vs. 39.0%, p = 0.044). SUVb > 6.9 indicated significantly poorer 5-year event-free survival (EFS) (12.5% vs. 59.3%, p = 0.005), as did SUVe > 1.2 (18.8% vs. 41.7%, p = 0.041). Children with SUVe > 1.2 had shorter 5-year OS (33.9% vs. 75.0%, p = 0.018). Multivariate analysis identified SUVe > 1.2 as an independent predictor for both EFS [hazard ratio (HR), 3.479, 95% CI, 1.381–8.761, p = 0.008] and OS (HR, 6.948, 95% CI, 1.663–29.025, p = 0.008), while SUVb > 6.9 was a predictor for EFS (HR, 2.889, 95% CI, 1.064–7.842, p = 0.037). Among 11 children with both SUVb > 6.9 and SUVe > 1.2, all experienced disease progression or relapse within 2 years since diagnosis.
Conclusion
18F-FDG PET/CT could be of useful to evaluate treatment response in children with stage 4 NB.
Clinical relevance statement
18F-FDG PET/CT after chemotherapy exhibits prognostic significance in neuroblastoma and holds potential as an alternative imaging modality for response evaluation, especially in cases with metaiodobenzylguanidine-nonavid or persistent avid disease.
Key Points
-
The prognostic value of chemotherapy response on 18F-FDG PET/CT in advanced neuroblastoma is unknown.
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Higher 18F-FDG uptake after chemotherapy was associated with worse long-term event-free survival and overall survival.
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18F-FDG PET/CT after chemotherapy holds prognostic significance in children with stage 4 neuroblastoma.
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Abbreviations
- 18F-DOPA:
-
18F-fluorodihydroxyphenylalanine
- AUC:
-
Area under the curve
- CCCG:
-
Chinese Children Cancer Group
- CMR:
-
Complete metabolic response
- EFS:
-
Event-free survival
- INRC:
-
International Neuroblastoma Response Criteria
- INSS:
-
International Neuroblastoma Staging System
- LDH:
-
Lactate dehydrogenase
- MIBG:
-
Metaiodobenzylguanidine
- NB:
-
Neuroblastoma
- NSE:
-
Neuron-specific enolase
- OS:
-
Overall survival
- ROC:
-
Receiver operating characteristic
- SUVb:
-
SUVmax of the lesion with the most intense 18F-FDG uptake at baseline
- SUVe:
-
SUVmax of the lesion with the most intense 18F-FDG uptake after chemotherapy
- ΔSUVmax:
-
Percentage change between SUVb and SUVe
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Funding
This study has received funding by the National Natural Science Fund (81901775).
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The scientific guarantor of this publication is Suyun Chen.
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Performed at one institution
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Lu, X., Li, C., Wang, S. et al. The prognostic role of 18F-FDG PET/CT-based response evaluation in children with stage 4 neuroblastoma. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10781-w
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DOI: https://doi.org/10.1007/s00330-024-10781-w