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Prognostic significance of pretreatment 18F-FDG positron emission tomography/computed tomography in pediatric neuroblastoma

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Abstract

Background

18F-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) shows tumor activity in most neuroblastomas, but the role of 18F-FDG PET/CT in neuroblastoma remains to be defined.

Objective

This study explored the prognostic significance of 18F-FDG PET in newly diagnosed neuroblastic tumors.

Materials and methods

This retrospective study reviewed all 18F-FDG PET/CT examinations performed for a new diagnosis of suspected neuroblastoma. MYCN amplification status, tumor recurrence and survival were abstracted from the medical record. Primary tumors were manually segmented to measure maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), tumor volume and total lesion glycolysis. Univariate and multivariable analyses using Cox proportional hazards regression testing assessed the predictive performance of PET indices for event-free survival and overall survival with thresholds determined using receiver operating characteristic curve analysis.

Results

Fifty-five children were included, with a median age of 2.9 years (interquartile range [IQR] 1.8–3.0 years). SUVmax, tumor volume and total lesion glycolysis were higher in MYCN-amplified tumors (P=0.012, P<0.0001, P<0.0001, respectively) and in higher International Neuroblastoma Risk Group (INRG) stages (P=0.0008, P=0.0017, P=0.0017, respectively). After adjusting for age, tumor SUVmax (P=0.028) and SUVmean (P=0.045) were associated with overall survival. An SUVmax threshold of 4.77 (P=0.028) best predicted overall survival, with median overall survival of 2,604 days (SUVmax>4.77) vs. >2,957 days (SUVmax≤4.77). No PET parameters were independently significantly associated with overall survival or event-free survival after controlling for MYCN status, stage or treatment risk stratification.

Conclusion

Tumor metabolic activity is higher in higher-stage MYCN-amplified neuroblastic tumors. Higher SUVmax and SUVmean were associated with worse overall survival but were not independent of other prognostic markers.

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Authors and Affiliations

  1. Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA

    Andrew J. Sung, Susan E. Sharp & Andrew T. Trout

  2. Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Brian D. Weiss

  3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Brian D. Weiss, Bin Zhang & Andrew T. Trout

  4. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Susan E. Sharp & Andrew T. Trout

  5. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Bin Zhang

Authors
  1. Andrew J. Sung
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  2. Brian D. Weiss
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  3. Susan E. Sharp
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  4. Bin Zhang
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  5. Andrew T. Trout
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Correspondence to Andrew T. Trout.

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Sung, A.J., Weiss, B.D., Sharp, S.E. et al. Prognostic significance of pretreatment 18F-FDG positron emission tomography/computed tomography in pediatric neuroblastoma. Pediatr Radiol 51, 1400–1405 (2021). https://doi.org/10.1007/s00247-021-05005-y

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  • DOI: https://doi.org/10.1007/s00247-021-05005-y

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