Diagnostic FDG and FDOPA positron emission tomography scans distinguish the genomic type and treatment outcome of neuroblastoma
Journal
Oncotarget
Journal Volume
7
Journal Issue
14
Pages
18774-18786
Date Issued
2016
Author(s)
Liu, Y.-L., Lu, M.-Y., Chang, H.-H., Lu, C.-C., Lin, D.-T., Jou, S.-T., Yang, Y.-L., Lee, Y.-L., Huang, S.-F., Jeng, Y.-M., Lee, H., Miser, J.S., Lin, K.-H., Liao, Y.-F., Hsu, W.-M., Tzen, K.-Y.
Lin D.-T.
Lee Y.-L.
Huang S.-F.
Lee H.
Miser J.S.
Lin K.-H.
Liao Y.-F.
Abstract
Neuroblastoma (NB) is a heterogeneous childhood cancer that requires multiple imaging modalities for accurate staging and surveillances. This study aims to investigate the utility of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and 18F-fluoro-dihydroxyphenylalanine (FDOPA) in determining the prognosis of NB. During 2007-2014, forty-two NB patients (male:female, 28:14; median age, 2.0 years) undergoing paired FDG and FDOPA PET scans at diagnosis were evaluated for the maximum standardized uptake value (SUVmax) of FDG or FDOPA by the primary tumor. Patients with older age, advanced stages, or MYCN amplification showed higher FDG and lower FDOPA SUVmax (all P < 0.02). Receiver operating characteristics analysis identified FDG SUVmax ? 3.31 and FDOPA SUVmax < 4.12 as an ultra-high-risk feature (PET-UHR) that distinguished the most unfavorable genomic types, i.e. segmental chromosomal alterations and/or MYCN amplification, at a sensitivity of 81.3% (54.4%-96.0%) and a specificity of 93.3% (68.1%-99.8%). Considering with age, stage, MYCN status, and anatomical image-defined risk factor, PET-UHR was an independent predictor of inferior event-free survival (multivariate hazard ratio, 4.9 [1.9-30.1]; P = 0.012). Meanwhile, the ratio between FDG and FDOPA SUVmax (G:D) correlated positively with HK2 (Spearman's ρ = 0.86, P < 0.0001) and negatively with DDC (ρ = -0.58, P = 0.02) gene expression levels, which might suggest higher glycolytic activity and less catecholaminergic differentiation in NB tumors taking up higher FDG and lower FDOPA. In conclusion, the intensity of FDG and FDOPA uptake on diagnostic PET scans may predict the tumor behavior and complement the current risk stratification systems of NB.
SDGs
Other Subjects
carboxylyase; fluorodeoxyglucose f 18; fluorodihydroxyphenylalanine f 18; radiopharmaceutical agent; unclassified drug; 6 fluorodopa f 18; DOPA; fluorodeoxyglucose f 18; radiopharmaceutical agent; age; Article; cancer prognosis; cancer staging; cancer survival; child; chromosome aberration; clinical article; correlational study; DDC gene; diagnostic test accuracy study; drug uptake; event free survival; female; gene amplification; genome; genotype; glycolysis; HK2 gene; human; male; maximum standardized uptake value; MYCN gene; neuroblastoma; overall survival; PET scanner; positron emission tomography; predictive value; receiver operating characteristic; risk factor; sensitivity and specificity; treatment outcome; tumor differentiation; analogs and derivatives; cohort analysis; diagnostic imaging; disease free survival; genetics; genomics; infant; metabolism; neuroblastoma; positron emission tomography; procedures; prognosis; treatment outcome; Cohort Studies; Dihydroxyphenylalanine; Disease-Free Survival; Female; Fluorodeoxyglucose F18; Genomics; Humans; Infant; Male; Neuroblastoma; Positron-Emission Tomography; Prognosis; Radiopharmaceuticals; Treatment Outcome
Publisher
Impact Journals LLC
Type
journal article