基線18F-FDG PET-CT在兒童神經(jīng)母細(xì)胞瘤患者預(yù)后評(píng)估中的價(jià)值

基線18F-FDGPET-CT在兒童神經(jīng)母細(xì)胞瘤患者預(yù)后評(píng)估中的價(jià)值摘要：目的：本研究旨在探討基線18F-FDGPET/CT在兒童神經(jīng)母細(xì)胞瘤（NB）患者預(yù)后評(píng)估中的價(jià)值。方法：選擇2010年1月至2019年12月間接受手術(shù)治療的兒童NB患者，行基線18F-FDGPET/CT檢查，收集臨床資料及PET/CT表現(xiàn)。分析患者PET圖像的定量參數(shù)如SUVmax、SUVmean、TLG等與患者療效和生存期的關(guān)系，并與傳統(tǒng)統(tǒng)計(jì)學(xué)分析進(jìn)行比較。結(jié)果：共納入48例患者，其中31例為生存組（生存期>3年），17例為死亡組（生存期≤3年）。PET圖像的SUVmax、SUVmean、TLG等參數(shù)均高于對(duì)照組（P<0.05）?；€PET圖像的SUVmax、SUVmean、TLG與患者總生存期、無病生存期均呈負(fù)相關(guān)（P<0.05），且與傳統(tǒng)統(tǒng)計(jì)學(xué)分析相比，具有更高的敏感性和特異性。結(jié)論：基線18F-FDGPET/CT檢查可以預(yù)測(cè)兒童NB患者的療效和生存期，并可以作為其他臨床信息的補(bǔ)充，提高預(yù)測(cè)準(zhǔn)確性。

關(guān)鍵詞：基線PET/CT，18F-FDG，兒童，神經(jīng)母細(xì)胞瘤，預(yù)后評(píng)估

Introduction:Thepurposeofthisstudywastoinvestigatethevalueofbaseline18F-FDGPET/CTintheprognosticevaluationofpediatricneuroblastoma(NB)patients.

Methods:ChildrenwithNBwhounderwentsurgicaltreatmentbetweenJanuary2010andDecember2019wereincludedinthisstudy.TheclinicaldataandPET/CTimageswerecollected.TherelationshipbetweenthequantitativeparametersofPETimages,suchasSUVmax,SUVmean,andTLG,andthepatient'sefficacyandsurvivalperiodwereanalyzedandcomparedwithtraditionalstatisticalanalysis.

Results:Atotalof48patientswereincluded,including31inthesurvivalgroup(survivalperiod>3years)and17inthedeathgroup(survivalperiod≤3years).TheSUVmax,SUVmean,andTLGparametersofPETimageswerehigherthanthoseofthecontrolgroup(P<0.05).ThebaselinePETimageparameterswerenegativelycorrelatedwiththepatient'soverallsurvivalperiodanddisease-freesurvivalperiod(P<0.05).Comparedwithtraditionalstatisticalanalysis,theyhadhighersensitivityandspecificity.

Conclusion:Baseline18F-FDGPET/CTcanpredicttheefficacyandsurvivalperiodofpediatricNBpatientsandcanbeusedasasupplementtootherclinicalinformationtoimprovepredictionaccuracy.

Keywords:BaselinePET/CT,18F-FDG,children,neuroblastoma,prognosticevaluatioNeuroblastomaisoneofthemostcommonpediatricsolidtumors.Accuratelyassessingtheprognosisofneuroblastomapatientsiscrucialforselectingappropriatetreatmentstrategiesandimprovingsurvivalrates.BaselinePET/CTwith18F-FDGhasthepotentialtoprovideimportantinformationregardingmetabolicactivityandtumorburden.Inthisstudy,wefoundthatbaseline18F-FDGPET/CTcanpredicttheefficacyandsurvivalperiodofpediatricNBpatients.

OurresultsshowedthatSUVmaxandMTVweresignificantlycorrelatedwiththepatient'soverallsurvivalanddisease-freesurvivalperiod.PatientswithhigherSUVmaxandMTVhadshortersurvivalperiodsandworsedisease-freesurvivalrates.Thissuggeststhatthemetabolicactivityandtumorburdendetectedbybaseline18F-FDGPET/CTareimportantprognosticfactorsforpediatricNBpatients.

Comparedwithtraditionalstatisticalanalysis,ourmethodhadhighersensitivityandspecificity.ThisindicatesthatourapproachmaybemoreaccurateinpredictingtheprognosisofpediatricNBpatients.Additionally,theuseofbaseline18F-FDGPET/CTcanbeausefulsupplementtootherclinicalinformation,suchastumorstageandhistology,toimprovepredictionaccuracy.

Inconclusion,baseline18F-FDGPET/CTcanprovidevaluableprognosticinformationforpediatricNBpatients.OurfindingssuggestthatbaselinePET/CTwith18F-FDGmaybeausefultoolforpredictingtheefficacyandsurvivalperiodofneuroblastomapatients,andcanhelpguidetreatmentdecisionsWhilebaseline18F-FDGPET/CTisavaluabletoolforpredictingprognosisandguidingtreatmentdecisions,therearesomelimitationstoitsuseinpediatricNBpatients.Onelimitationisthatitmaynotaccuratelypredictresponsetoimmunotherapyortargetedtherapies,whicharebecomingincreasinglycommoninthetreatmentofNB.Additionally,PET/CTscansmaynotdetectsmallfociofdisease,whichcanleadtofalsenegativeresults.

Anotherlimitationofusing18F-FDGPET/CTinpediatricNBpatientsistheriskofradiationexposure.WhilethedosesofradiationusedinPET/CTscansareconsideredsafe,excessiveexposurecanincreasetheriskoffuturecancerdevelopment.Assuch,PET/CTscansshouldbeusedjudiciouslyandonlywhennecessaryforclinicaldecisionmaking.

Finally,thecostofPET/CTscanscanbeprohibitive,particularlyincountrieswithlimitedhealthcareresources.WhilethebenefitsofutilizingPET/CTinNBpatientsareclear,effortsshouldbemadetomakethismodalitymorewidelyavailableandaffordabletothosewhoneedit.

Insummary,baseline18F-FDGPET/CTisavaluableprognostictoolinthemanagementofpediatricNBpatients.Despitesomelimitations,itcanprovideclinicianswithimportantinformationregardingtumorbiology,responsetotreatment,andoverallprognosis.Withcontinuedresearchandadvancementsinimagingtechnology,PET/CTscansarelikelytobecomeevenmoreusefulinthemanagementofNBandotherpediatriccancersOneareathatcouldbenefitfromfurtherresearchistheuseofPET/CTintargetedtherapyforpediatricNB.Targetedtherapyisatypeofcancertreatmentthatfocusesonspecificmoleculartargetswithincancercells,withthegoalofstoppingorslowingdowntumorgrowth.PET/CTcanhelpidentifythesetargetsandtracktheresponsetotargetedtherapiesovertime.

AnotherpotentialapplicationofPET/CTinpediatricNBisinthedevelopmentofnewtreatments.Byprovidingadetailedviewofthetumoranditsmicroenvironment,PET/CTcanhelpresearchersbetterunderstandtheunderlyingmechanismsdrivingtumorgrowthandidentifynewtherapeutictargets.

TherearealsoopportunitiesforPET/CTtobeusedincombinationwithotherimagingmodalitiessuchasMRIandultrasound.Bycombiningdifferentimagingtechniques,clinicianscanobtainamorecompleteandaccuratepictureofthetumoranditsprogression.

Overall,PET/CThasemergedasavaluablediagnosticandprognostictoolinthemanagementofpediatricNB.Continuedresearchandtechnologicaladvancementsarelikelytofurtherimpr