Initial metabolic tumor volume measured by 18F-FDG PET/CT can predict the outcome of osteosarcoma of the extremities.
We evaluated the ability of metabolic and volumetric parameters measured by pretreatment (18)F-FDG PET/CT to predict the survival of patients with osteosarcoma of the extremities.


METHODS
The records of 83 patients with American Joint Committee on Cancer stage II extremity osteosarcoma treated with surgery and chemotherapy were retrospectively reviewed. Imaging parameters (maximum standardized uptake value, metabolic tumor volume [MTV], total lesion glycolysis, and tumor volume based on MR images) were measured before treatment, and histologic responses to neoadjuvant chemotherapy were assessed by examination of postsurgical specimens. Receiver-operating-characteristic curve analyses and the Cox proportional hazards model were used to analyze whether imaging and clinicopathologic parameters could predict metastasis-free survival.


RESULTS
Of the imaging parameters, MTV at the fixed standardized uptake value threshold of 2.0 (MTV(2.0)) most accurately predicted metastasis by receiver-operating-characteristic curve analysis (area under the curve = 0.679, P = 0.011). By multivariate analysis, MTV(2.0) > 105 mL (relative risk, 3.93; 95% confidence interval, 1.55-9.92) and poor response to neoadjuvant chemotherapy (relative risk, 4.83; 95% confidence interval, 1.64-14.21) independently shortened metastasis-free survival (P = 0.004 for both parameters). The stratification of patients by the combined criteria of MTV(2.0) and histologic response predicted outcome in more detail.


CONCLUSIONS
MTV is an independent predictor of metastasis in patients with osteosarcoma of the extremities. The combination of MTV and histologic response predicts survival more accurately than the chemotherapeutic response alone.
Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
Byung Hyun
BH
Byun
Chang-Bae
CB
Kong
Jihyun
J
Park
Youngseok
Y
Seo
Ilhan
I
Lim
Chang Woon
CW
Choi
Wan Hyeong
WH
Cho
Dae-Geun
DG
Jeon
Jae-Soo
JS
Koh
Soo-Yong
SY
Lee
Sang Moo
SM
Lim
D000293:Adolescent; D000328:Adult; D002648:Child; D005121:Extremities / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D012516:Osteosarcoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D055815:Young Adult
D019788:Fluorodeoxyglucose F18
18F-FDG; PET/CT; metabolic tumor volume; osteosarcoma; survival