Prognostic significance of [18F]FDG PET metabolic parameters in adults and children with soft-tissue sarcoma: a meta-analysis

Soft-tissue sarcomas (STS) represent a diverse group of rare malignancies, underscoring the need for precise risk stratification. [18F]fluoro‑2‑deoxy‑2‑d‑glucose positron emission tomography ([18F]FDG PET) imaging parameters have been proposed as potential prognostic indicators in several cancer types, yet their significance in STS remains under investigation. This study aimed to synthesize the available evidence and assess the prognostic value of these parameters. A systematic review and meta-analysis was conducted, employing a comprehensive literature search across multiple databases. The prognostic value of [18F]FDG PET parameters, including pre- and post- treatment standardized uptake values (SUV1, SUV2), pretreatment metabolic tumor volume (MTV1) and total lesion glycolysis (TLG1) on event-free survival (EFS) and overall survival (OS) in patients with STS was examined. Thirty-one studies with 1,932 patients were identified. The analyses demonstrated significant relationships between higher SUV1 (hazard ratio, HR 1.68 for EFS and 3.07 for OS, p < 0.001), SUV2 (HR 3.13 for EFS and 2.09 for OS, p < 0.001 and p = 0.001 respectively), MTV1 (HR 2.29 for EFS and 3.05 for OS, p = 0.011 and p < 0.001 respectively), TLG1 (HR 2.85 for EFS and 3.23 for OS, p = 0.032 and p = 0.002 respectively) and poorer survival outcomes. However, the association of these parameters with survival outcomes was non-significant in pediatric patients. This study suggests that [18F]FDG PET parameters could serve as important prognostic markers in adults with STS, but not in pediatric patients. Future studies with larger cohorts and uniform methodologies are critical to confirm and build upon these findings.