Abstract
BackgroundThe use of 18F-FDG Positron emission tomography/Computed tomography (PET/CT) in the initial staging of many cancers is clearly established. Most soft tissue sarcoma (STS) has a high affinity for 18F-FDG, which is why 18F-FDG PET/CT has been proposed as a non-invasive method, useful in diagnosis and follow-up. The standardized uptake value values (SUV), the volume-based metabolic parameters MTV (metabolic tumor volume), and TLG (total lesion glycolysis) determine tumor viability and provide its total volume and the total activity of metabolically active tumor cells. The histological grade is the most important predictor of metastases and mortality associated with STS, and a significant relationship between the metabolic parameters of 18F-FDG PET/CT and the histological grade has been described.MethodsA retrospective study was conducted on STS patients, who had histological grade according to the FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) criteria, as well as a baseline PET/CT. SUV (SUVmax, SUVmean, and SUVpeak), MTV, and TLG were quantified. A T-student test was performed to establish the relationship between the metabolic biomarkers and the histological grade. Their usefulness as predictors of the histological grade was verified using receiver operator characteristic (ROC) curves. A survival function study was performed using the Kaplan–Meier method. To assess the prognostic utility of the metabolic biomarkers we use the Log-Rank method.ResultsThe SUV values were useful to discriminate high-grade STS. We found a significant relationship between the histological grade and the SUV values. SUVmax, SUVpeak, MTV, and TLG were predictors of overall survival (OS). There were no significant differences in the OS for the SUVmean, or in the disease-free survival (DFS) for SUVmax, SUVmean, SUVpeak, MTV, and TLG.ConclusionsThe SUVmax, SUVmean, and SUVpeak values correlate with the HG and are useful to discriminate high-grade from low-grade STS. Patients with high SUVmax, SUVpeak, MTV, and TLG have a significantly lower OS.
Highlights
Soft tissue sarcomas (STS) are a group of rare tumors derived from mesenchymal tissues, whose cells develop in the circulatory and lymphatic systems, as well as in structural and connective tissues
Materials and methods A retrospective study was conducted on patients diagnosed with soft tissue sarcoma (STS) who had histological grade according to the FNCLCC criteria, as well as a baseline 18F] fluoro-D-glucose (18F-FDG) Positron emission tomography/Computed tomog‐ raphy (PET/CT)
The usefulness of the metabolic parameters measured in the baseline PET/CT to discriminate high-grade from low-grade soft tissue sarcomas, was established using receiver operator character‐ istic (ROC) curves, setting the following values as significant cut-off points: SUVmax 3.9 [AuC 0,824], SUVmean 2,5 [AuC 0.798] and SUVpeak 3.73 [AuC 0.817], being the SUVmax value the most accurate
Summary
Soft tissue sarcomas (STS) are a group of rare tumors derived from mesenchymal tissues, whose cells develop in the circulatory and lymphatic systems, as well as in structural and connective tissues. Tumors that derive from peripheral nerves by convention are classified as sarcomas, despite their embryological origin in the neural crest. Their great variety is due to the tissues in which they originate, with diverse clinical and biological behavior (Beckingsale and Shaw 2017). In the United States (U.S.), 13,130 new STS were diagnosed (7240 males and 5510 females) in 2020 (Key Statistics for Soft Tissue Sarcomas 2019). Both sexes are affected; the incidence is higher in females in the 45–49 age group, due to gynecological tumors (Beckingsale and Shaw 2017; López-Pousa et al 2016). The histological grade is the most important predictor of metastases and mortality associated with STS, and a significant relationship between the metabolic parameters of 18F-FDG PET/CT and the histological grade has been described
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