Jens Gempt1, Stefanie Bette2, Yu-Mi Ryang2, Niels Buchmann2, Patrick Peschke2, Thomas Pyka3, Hans-Jürgen Wester3, Stefan Förster3, Bernhard Meyer2, Florian Ringel2. 1. Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany. Electronic address: jens.gempt@tum.de. 2. Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany. 3. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
Abstract
INTRODUCTION: Histopathological examination is the standard for grading and determination of diagnosis in intrinsic brain tumors though the possibility of malignization and tumor heterogeneity always bears the possibility of tumor under-grading or misjudgement regarding the estimation of prognosis. The aim of the present study was to evaluate the use of (18)F-FET-PET (FET-PET) for the grading and estimation of prognosis in newly diagnosed patients with intracranial gliomas in a clinical setting. METHODS: Patients who were treated for a newly diagnosed intracranial glioma between January 2007 and May 2012, and had a preoperative FET-PET and MRI scan between were included. The ratio of counts in a tumor VOI (volume of interest) with maximum uptake to the respective counts in a background VOI was calculated to provide the tumor-to-normal (T/N) ratio. The clinical and histopathological data (tumor grading, pre- and postoperative neurological status, Karnofsky Performance Status Scale scores, and overall survival rates) were recorded. RESULTS: One hundred fifty-two patients (39 WHO II, 26 WHO III, 87 WHO IV) were included. The median T/N ratio was 2.81 (1.1-8.1). The median T/N ratio of low-grade glioma patients was 1.65 (1.1-3.7), and 3.14 (1.61-8.1, p<0.001) in high-grade glioma patients. The median survival for patients with WHO III tumors was 22.8 months (95% CI: 15.87%-NA) and 13.23 months (95% CI: 10.83-15.6.%) for patients with WHO IV tumors (p=0.0001). For T/N≤1.6, no deaths were recorded; for 1.6<T/N≤3, median survival was 25.6 months (95% CI: 16.5%-NA), while for T/N>3, median survival was 14.0 months (95% CI: 11.7-16.2%, p<0.001). The test of the maximally selected log-rank statistic resulted in a T/N ratio of 1.88 as the cut-off value, with the greatest difference in overall survival between patients with longer and shorter survival. The ROC curve for differentiation of low- vs. high-grade tumors with regard to the T/N ratio showed an area under the curve (AUC) of 0.903. Regarding the prognostic validity for overall survival ROC-curves for 12-month, 24-month and 48-month survival display a higher validity for the WHO-classification than for the imaging modalities though with an AUC of 0.847 for the 48-month survival T/N ratio and MRI contrast-enhancement have a high prognostic value as well. CONCLUSION: Our study suggests that FET-PET can predict prognosis and survival in patients harboring intracranial gliomas and serves as a valuable tool to supplement the established clinical and histopathological parameters.
INTRODUCTION: Histopathological examination is the standard for grading and determination of diagnosis in intrinsic brain tumors though the possibility of malignization and tumor heterogeneity always bears the possibility of tumor under-grading or misjudgement regarding the estimation of prognosis. The aim of the present study was to evaluate the use of (18)F-FET-PET (FET-PET) for the grading and estimation of prognosis in newly diagnosed patients with intracranial gliomas in a clinical setting. METHODS:Patients who were treated for a newly diagnosed intracranial glioma between January 2007 and May 2012, and had a preoperative FET-PET and MRI scan between were included. The ratio of counts in a tumor VOI (volume of interest) with maximum uptake to the respective counts in a background VOI was calculated to provide the tumor-to-normal (T/N) ratio. The clinical and histopathological data (tumor grading, pre- and postoperative neurological status, Karnofsky Performance Status Scale scores, and overall survival rates) were recorded. RESULTS: One hundred fifty-two patients (39 WHO II, 26 WHO III, 87 WHO IV) were included. The median T/N ratio was 2.81 (1.1-8.1). The median T/N ratio of low-grade gliomapatients was 1.65 (1.1-3.7), and 3.14 (1.61-8.1, p<0.001) in high-grade gliomapatients. The median survival for patients with WHO III tumors was 22.8 months (95% CI: 15.87%-NA) and 13.23 months (95% CI: 10.83-15.6.%) for patients with WHO IV tumors (p=0.0001). For T/N≤1.6, no deaths were recorded; for 1.6<T/N≤3, median survival was 25.6 months (95% CI: 16.5%-NA), while for T/N>3, median survival was 14.0 months (95% CI: 11.7-16.2%, p<0.001). The test of the maximally selected log-rank statistic resulted in a T/N ratio of 1.88 as the cut-off value, with the greatest difference in overall survival between patients with longer and shorter survival. The ROC curve for differentiation of low- vs. high-grade tumors with regard to the T/N ratio showed an area under the curve (AUC) of 0.903. Regarding the prognostic validity for overall survival ROC-curves for 12-month, 24-month and 48-month survival display a higher validity for the WHO-classification than for the imaging modalities though with an AUC of 0.847 for the 48-month survival T/N ratio and MRI contrast-enhancement have a high prognostic value as well. CONCLUSION: Our study suggests that FET-PET can predict prognosis and survival in patients harboring intracranial gliomas and serves as a valuable tool to supplement the established clinical and histopathological parameters.
Authors: Peggy Gandia; Cyril Jaudet; Hendrik Everaert; Johannes Heemskerk; Anne Marie Vanbinst; Johan de Mey; Johnny Duerinck; Bart Neyns; Mark de Ridder; Etienne Chatelut; Didier Concordet Journal: Clin Pharmacokinet Date: 2017-08 Impact factor: 6.447
Authors: Vincent Dunet; Anastasia Pomoni; Andreas Hottinger; Marie Nicod-Lalonde; John O Prior Journal: Neuro Oncol Date: 2015-08-04 Impact factor: 12.300
Authors: Manuel Röhrich; Anastasia Loktev; Annika K Wefers; Annette Altmann; Daniel Paech; Sebastian Adeberg; Paul Windisch; Thomas Hielscher; Paul Flechsig; Ralf Floca; Dominik Leitz; Julius P Schuster; Peter E Huber; Jürgen Debus; Andreas von Deimling; Thomas Lindner; Uwe Haberkorn Journal: Eur J Nucl Med Mol Imaging Date: 2019-08-06 Impact factor: 9.236
Authors: Christian F Freyschlag; Sandro M Krieg; Johannes Kerschbaumer; Daniel Pinggera; Marie-Therese Forster; Dominik Cordier; Marco Rossi; Gabriele Miceli; Alexandre Roux; Andrés Reyes; Silvio Sarubbo; Anja Smits; Joanna Sierpowska; Pierre A Robe; Geert-Jan Rutten; Thomas Santarius; Tomasz Matys; Marc Zanello; Fabien Almairac; Lydiane Mondot; Asgeir S Jakola; Maria Zetterling; Adrià Rofes; Gord von Campe; Remy Guillevin; Daniele Bagatto; Vincent Lubrano; Marion Rapp; John Goodden; Philip C De Witt Hamer; Johan Pallud; Lorenzo Bello; Claudius Thomé; Hugues Duffau; Emmanuel Mandonnet Journal: J Neurooncol Date: 2018-07-10 Impact factor: 4.130
Authors: Jan C Peeken; Tatyana Goldberg; Thomas Pyka; Michael Bernhofer; Benedikt Wiestler; Kerstin A Kessel; Pouya D Tafti; Fridtjof Nüsslin; Andreas E Braun; Claus Zimmer; Burkhard Rost; Stephanie E Combs Journal: Cancer Med Date: 2018-12-18 Impact factor: 4.452
Authors: Maria Waltenberger; Jennifer Furkel; Manuel Röhrich; Patrick Salome; Charlotte Debus; Bouchra Tawk; Aoife Ward Gahlawat; Andreas Kudak; Matthias Dostal; Ute Wirkner; Christian Schwager; Christel Herold-Mende; Stephanie E Combs; Laila König; Jürgen Debus; Uwe Haberkorn; Amir Abdollahi; Maximilian Knoll Journal: Front Oncol Date: 2022-09-20 Impact factor: 5.738