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Turkish Journal of Medical Sciences

Abstract

Background/aim: This study assessed correlations between intratumoral heterogeneity, survival outcomes, and baseline 18F-FDG PET/ CT-derived semiquantitative metabolic parameters and histological subtype in patients with bone sarcomas.

Materials and methods: We retrospectively analyzed 44 patients with biopsy-proven bone sarcomas who underwent baseline 18F-FDG PET/CT before treatment. Total lesion glycolysis, metabolic tumor volume, heterogeneity indices (HI1, HI2, HI3), and semiquantitative standardized uptake parameters (SUVmax, SUVmean, SUVpeak, and SUVmin), all derived from the primary tumor, were examined. SUVmin and SUVmax AUCs were compared using the DeLong test. Kaplan–Meier survival analysis, Cox regression, correlation analysis, and ROC analysis were used to assess associations with clinicopathological characteristics, survival outcomes, and metastatic status.

Results: Tumor volume and diameter differed according to vital status, being higher in patients who died during follow-up (p = 0.024 and p = 0.032, respectively). Osteosarcoma showed nominally higher SUVmax, SUVmin, SUVmean, and HI1 values than Ewing sarcoma. HI2 showed a strong inverse correlation with tumor volume (r = –0.80, p < 0.001) but was not significantly associated with AJCC stage (p = 0.26). SUVmin was nominally higher in deceased patients and had the highest AUC for discriminating vital status (AUC: 0.713, sensitivity: 80%, specificity: 69%, p = 0.014); the SUVmin and SUVmax ROC curves did not differ significantly (DeLong p = 0.165). Metabolic parameters did not significantly discriminate metastatic from nonmetastatic disease (p > 0.05 for all).

Conclusion: Tumor burden, stage, and survival in bone sarcomas correlated strongly with baseline 18F-FDG PET/CT-derived metabolic and heterogeneity characteristics. SUVmin showed the highest discriminative ability for vital status among the tested parameters but did not significantly outperform SUVmax in ROC comparisons, highlighting the limitations of single-voxel measures. These data support the implementation of multiparametric PET/CT for more granular risk stratification and biological profiling, but further investigation in broader prospective cohorts is required.

Author ORCID Identifier

HALİM ÖZÇEVİK: 0000-0001-7201-9868

MÜGE ÖNER TAMAM: 0000-0002-3793-0178

MERYEM ESLEM BİÇEN ALTIN: 0009-0009-1416-961X

CÜNEYT TAMAM: 0000-0001-6807-3300

MERVE NUR ACAR TAYYAR: 0009-0001-4126-7778

MEHMET MESUT SÖNMEZ: 0000-0002-8646-2067

DOI

10.55730/1300-0144.6388

Keywords

18F-FDG PET/CT, intratumoral heterogeneity, metabolic tumor volume, osteosarcoma, prognosis, SUVmin

First Page

1430

Last Page

1441

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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