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Prognostic significance of [18F]FDG PET metabolic parameters in osteosarcoma and Ewing’s sarcoma: a systematic review and network meta-analysis

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Abstract

Background

Osteosarcomas (OSTs) and Ewing’s sarcomas (EWSs) present significant challenges in pediatric and adolescent oncology due to their diverse pathological features and clinical behaviors. The advent of [18F]fluoro-2-deoxy-2-d-glucose positron emission tomography ([18F]FDG PET) has introduced new potential prognostic parameters, such as the SUVmax, MTV, and TLG, but their predictive value in patients with OST and EWS remains debatable.

Methods

This systematic review and network meta-analysis were conducted in accordance with PRISMA-NMA guidelines. A comprehensive literature search covered studies from the last 15 years on [18F]FDG PET metabolic parameters in patients with OST and EWS. The prognostic value of [18F]FDG PET parameters, including pre- and posttreatment standardized uptake values (SUV1, SUV2 and the SUV2/SUV1 ratio), metabolic tumor volume (MTV1, MTV2) and total lesion glycolysis (TLG1, TLG2), on event-free survival and overall survival in patients with OST and EWS was examined. The data analysis involved traditional and network meta-analyses (NMA), including subgroup analyses and meta-regression.

Results

Our analysis included 20 studies with 858 patients. We found significant associations between higher SUV1, SUV2, MTV1 and TLG1 and survival outcomes. The NMA revealed the superior predictive strength of SUV2, MTV, and TLG over SUV1. Subgroup analysis highlighted the variable prognostic value of these parameters, particularly between pediatric and adult patients.

Conclusion

Our study suggested that [18F]FDG PET parameters, particularly SUV2, MTV1, and TLG1, have significant prognostic value in patients with OST and EWS. Further research involving larger cohorts and standardized methodologies is essential to confirm and build upon these findings.

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Data availability

The authors declare that all the data supporting the findings of this study are available within the article.

Abbreviations

[18F]FDG:

[18F]fluoro‑2‑deoxy‑2‑d‑glucose

OST:

Osteosarcoma

CI:

Confidence interval

EFS:

Event-free survival

EWS:

Ewing’s sarcoma

FDA:

Food and Drug Administration

HR:

Hazard ratio

INPLASY:

International Platform of Registered Systematic Review and Meta-analysis Protocols

MTV:

metabolic tumor volume

NAC:

Neoadjuvant Chemotherapy

NMA:

Network meta-analysis

OS:

overall survival

PET:

Positron emission tomography

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PRISMA-NMA:

PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health care interventions

REML:

restricted maximum likelihood

ROC:

Receiver operating characteristic

STS:

Soft-tissue sarcoma

SUV:

standardized uptake value

SUVmax:

Maximum standardized uptake value

TLG:

Total lesion glycolysis

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Authors and Affiliations

  1. Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela str. 1, 117997, Moscow, Russia

    Mikhail Ya. Yadgarov, E. I. Konopleva, A. I. Karachunskiy & Yu. N. Likar

  2. V. A. Negovsky Research Institute of General Reanimatology of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia

    Mikhail Ya. Yadgarov & L. B. Berikashvili

  3. K+31 City Hospital, Moscow, Russia

    E. S. Rakova

  4. Department of PET and radionuclide diagnostics, Samory Mashela str. 1, 117997, Moscow, Russia

    Mikhail Ya. Yadgarov

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Contributions

M.Y., Y.L. and E.R. collected the data. M.Y., L.B., and Y.L. contributed data and analysis tools. M.Y. performed the analysis. M.Y., L.B., and Y.L. assessed the risk of bias and certainty of evidence rating. M.Y., E.R., E.K., A.K., and Y.L. wrote the paper. E.K., A.K., and Y.L. revised the manuscript. All authors reviewed the manuscript.

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Correspondence to Mikhail Ya. Yadgarov.

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Yadgarov, M.Y., Berikashvili, L.B., Rakova, E.S. et al. Prognostic significance of [18F]FDG PET metabolic parameters in osteosarcoma and Ewing’s sarcoma: a systematic review and network meta-analysis. Clin Transl Imaging (2024). https://doi.org/10.1007/s40336-024-00645-0

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