Prognostic Stratification of Standard Responders to Neoadjuvant Chemotherapy in
Patients with Osteosarcoma Using (18)F-FDG PET/CT Imaging
#MMPMID41220604
Takemori T
; Kobayashi E
; Yoshida A
; Arakawa A
; Kondo H
; Kamio S
; Shimomura S
; Osaki S
; Ogura K
; Iwata S
; Ogawa C
; Kawai A
; Ito K
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41220604
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INTRODUCTION: We aimed to identify a new biomarker using (18)F-fluorodeoxyglucose
((18)F-FDG) positron emission tomography (PET)/computed tomography (CT)
parameters to identify osteosarcoma patients with standard response after
neoadjuvant chemotherapy (NAC). PATIENTS AND MATERIALS: Fifty-four patients with
conventional osteosarcoma (age ?39 years) were included in this study. All
patients underwent (18)F-FDG PET/CT before (PET1) and after NAC (PET2). We
measured PET parameters, including maximum, average, and peak standardized uptake
value (SUVmax, SUVave, and SUVpeak); metabolic tumor volume (MTV); and total
lesion glycolysis (TLG). Their changes (?PET = PET2/PET1) were also examined. The
patients were classified into 4 groups based on the histological tumor necrosis
rate (TNR): G0 (<50%), G1 (50 to < 90%), G2 (90 to < 100%), and G3 (100%). G0 and
G1 patients were enrolled in the standard responder (SR) group (n = 35), while G2
and G3 patients were enrolled in the good responder (GR) group (n = 19). We
examined the correlation between changes in each (18)F-FDG PET/CT parameter and
TNR as well as overall survival (OS) and progression-free survival (PFS) among
the 4 groups. In the SR group, the median value of ?SUVmax was calculated and
correlated with prognostic stratification. RESULTS: The changes in each PET
parameter were correlated with TNR, with SUVpeak showing the strongest
correlation. Moreover, in the SR group, there were no differences in OS or PFS
between G0 and G1. Patients in the SR group were stratified into 2 groups
according to the median ?SUVmax value (0.62). Patients with ?SUVmax < 0.62 had
significantly better OS (P < 0.01) and PFS (P = 0.02) in comparison with patients
with ?SUVmax ? 0.62. In multivariate analyses, ?SUVmax showed a correlation with
OS in the SR group. DISCUSSION: This study revealed that ?SUVmax may confirm the
preoperative stratification of the prognosis be a predictive biomarker for
patients in the SR group. Moreover, the preoperative identification of patients
with a worse prognosis in the SR group has a significant impact on improving the
clinical outcomes of patients with osteosarcoma. LEVEL OF EVIDENCE: Prognostic
studies, Level III. See Instructions for Authors for a complete description of
levels of evidence.
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