Prognostic significance of [18F]FDG PET metabolic parameters in osteosarcoma and Ewing’s sarcoma: a systematic review and network meta-analysis

Osteosarcomas (OSTs) and Ewing’s sarcomas (EWSs) present significant challenges in pediatric and adolescent oncology due to their diverse pathological features and clinical behaviors. The advent of [18F]fluoro-2-deoxy-2-d-glucose positron emission tomography ([18F]FDG PET) has introduced new potential prognostic parameters, such as the SUVmax, MTV, and TLG, but their predictive value in patients with OST and EWS remains debatable. This systematic review and network meta-analysis were conducted in accordance with PRISMA-NMA guidelines. A comprehensive literature search covered studies from the last 15 years on [18F]FDG PET metabolic parameters in patients with OST and EWS. The prognostic value of [18F]FDG PET parameters, including pre- and posttreatment standardized uptake values (SUV1, SUV2 and the SUV2/SUV1 ratio), metabolic tumor volume (MTV1, MTV2) and total lesion glycolysis (TLG1, TLG2), on event-free survival and overall survival in patients with OST and EWS was examined. The data analysis involved traditional and network meta-analyses (NMA), including subgroup analyses and meta-regression. Our analysis included 20 studies with 858 patients. We found significant associations between higher SUV1, SUV2, MTV1 and TLG1 and survival outcomes. The NMA revealed the superior predictive strength of SUV2, MTV, and TLG over SUV1. Subgroup analysis highlighted the variable prognostic value of these parameters, particularly between pediatric and adult patients. Our study suggested that [18F]FDG PET parameters, particularly SUV2, MTV1, and TLG1, have significant prognostic value in patients with OST and EWS. Further research involving larger cohorts and standardized methodologies is essential to confirm and build upon these findings.