Prognostic significance of 18F-FDG uptake in primary osteosarcoma after but not before chemotherapy: a possible association with autocrine motility factor/phosphoglucose isomerase expression

Response to neoadjuvant chemotherapy is a significant prognostic factor for osteosarcoma (OS). 18-F-fluorodeoxy-D-glucose (FDG) positron emission tomography (PET) is a noninvasive imaging modality that correlates with histological grading in musculoskeletal sarcomas. To determine the prognostic value of FDG PET in patients receiving chemotherapy, 13 patients were evaluated by FDG-PET, and followed for more than 4 years. FDG PET standardized uptake values before (SUV1) and after (SUV2) chemotherapy were analyzed and correlated with the expression of metastasis-related glycolytic enzyme, autocrine motility factor (AMF)/phosphoglucose isomerase (PGI) by immunohistochemical examination in surgically excised tumors. Although mean SUV1 for OS patients with metastatic lesions were similar to those in the completely disease-free (CDF) group (6.5 vs. 6.6, respectively, P = 0.975), mean SUV2 for OS with metastatic lesions were significantly higher than those in the CDF group (5.1 vs. 2.5, respectively, P = 0.0445). Interestingly, immunohistochemical analysis using anti-AMF/PGI antibody revealed that SUV2 correlated significantly with the AMF/PGI staining titers (P = 0.0303), while no correlation between SUV1 and the AMF/PGI staining titers existed (P = 0.964). The present study suggests that FDG PET after chemotherapy may provide information for AMF/PGI-related metastatic potentiality of residual tumors located out side of the area surgically resected afterward, and then lead to a useful prediction of the patients' prognosis.