Postoperative [18F]FDOPA and [18F]FDG PET Semiquantitative Scoring System for Risk Stratification in Neuroblastoma: A Three-tier Classification Approach
Chia-Ju Liu, Kuan-Yin Ko, Iu-Ning Sik, Meng-Yao Lu, Wan-Ting Hung, Shu-Wei Chou, Chia-Jui Du, Hsiu-Hao Chang, Wen-Ming Hsu, Yung-Li Yang, Cheng Hsu, Shinn-Forng Peng, Mei-Fang ChengBackground:
Postoperative disease assessment in neuroblastoma remains challenging. We aimed to develop and validate a postoperative semiquantitative dual-tracer PET scoring system integrating [ 18 F]FDOPA and [ 18 F]FDG PET for outcome stratification in pediatric neuroblastoma.
Patients and Methods:
In this retrospective single-center study, 46 patients with histologically confirmed neuroblastoma who underwent curative-intent surgery, followed by postoperative dual-tracer PET/CT between 2014 and 2023, were included. Both PET studies were interpreted using a 3-point visual scoring system based on lesion uptake intensity (1: no abnormal uptake, 2: higher than background, and 3: intense uptake ≥3× liver SUVmean). Patients were stratified into dual PET-defined low, intermediate, and high-risk groups. Event-free survival (EFS) and overall survival (OS) were analyzed using Kaplan–Meier and multivariable Cox regression analyses. The discriminatory ability of the dual-tracer PET classification was quantified using Harrell C-index.
Results:
Median patient age was 2.4 years, and 82.6% were classified as INRG high-risk. Median follow-up was 57.1 months. Patients were stratified into low risk (both scores = 1, n = 18), high risk (either score = 3, n = 9), and intermediate risk (remaining combinations, n = 19). The classification demonstrated significantly different 3-year EFS and OS rates: low-risk (94%, 100%), intermediate-risk (43%, 83%), and high-risk (11%, 42%). The dual PET model showed superior prognostic performance compared with single-tracer assessment (EFS C-index: 0.819 vs. 0.781 for FDG and 0.747 for FDOPA; OS C-index: 0.799 vs. 0.797 and 0.689, respectively). Dual PET classification remained an independent predictor after adjustment for age, MYCN amplification, and INRG classification.
Conclusions:
Postoperative dual-tracer PET provides robust prognostic stratification in pediatric neuroblastoma and may serve as a practical imaging biomarker for risk-adapted management.