Necrosis on FDG PET/CT Correlates With Prognosis and Mortality in Sarcomas

作者：Rakheja Rajan^*; Makis William; Tulbah Rima; Skamene Sonia; Holcroft Christina; Nahal Ayoub; Turcotte Robert; Hickeson Marc

来源：American Journal of Roentgenology, 2013, 201(1): 170-177.

DOI：10.2214/AJR.12.9795

• FDG
• F-18-FDG PET/CT
• necrosis
• prognosis
• sarcoma

OBJECTIVE. The purpose of this study was to determine if there is an association between necrosis as identified on staging F-18-FDG PET/CT and overall survival (OS) and progression-free survival (PFS) in patients with sarcoma.
MATERIALS AND METHODS. Sixty-six patients with newly diagnosed limb and girdle sarcoma underwent PET/CT at our institution between June 2004 and July 2009 for sarcoma staging before treatment with curative intent. The tumor maximum standardized uptake values (SUVmax), the presence of necrosis, and the volume of necrosis were measured for each primary tumor and correlated with follow-up data. PFS and OS were analyzed using the Kaplan-Meier method. Proportional hazards models were used to estimate hazard ratios.
RESULTS. Median patient age was 49 years, and 51.6% of the patients were men. Sarcomas were categorized as soft tissue (69.2%), bone (23.5%), or other (7.3%). Mean follow-up time was 33.3 months. During the follow-up interval, 53% of patients experienced disease progression, and 40.9% died. There was a statistically significant relationship between the presence of necrosis and OS (by log-rank test, p = 0.001), as well as PFS (by log-rank test, p = 0.0001). Twenty-four-month OS was 96%, 65%, and 38% in patients with tumors with absence necrosis, those with presence of necrosis, and with necrosis volume greater than 50%, respectively. Forty-eight-month OS was 81% in patients with absence of necrosis and 41% in patients with presence of necrosis. Twelve-month PFS was 96%, 60%, and 42% in patients with tumors with absence of necrosis, those with presence of necrosis, and those with necrosis volume greater than 50%, respectively. Twenty-four-month PFS was 83%, 38%, and 22%, respectively, in these groups.
CONCLUSION. The presence of necrosis and the volume of necrosis, as identified on the staging FDG PET/CT and after adjusting for SUVmax, are strong independent adverse prognostic factors for disease recurrence and death in patients with limb and girdle sarcomas.

• 出版日期2013-7