Wong R J, Lin D T, Schöder H, Patel S G, Gonen M, Wolden S, Pfister D G, Shah J P, Larson S M, Kraus D H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 2002 Oct 15;20(20):4199-208. doi: 10.1200/JCO.2002.02.590.
Patients with recurrent head and neck squamous cell carcinoma (HNSCC) present a diagnostic and therapeutic challenge. We evaluated the diagnostic accuracy and prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography (PET) in this patient population.
We performed a retrospective review of 143 patients with previously treated HNSCC who underwent 181 PET scans at our institution from May 1996 through April 2001 to detect recurrent disease. Disease recurrence within 6 months was used as the gold standard for assessing true disease status at PET.
With equivocal sites considered positive, the sensitivity and specificity of PET for detecting recurrence overall were 96% and 72%, respectively. PET was highly sensitive and specific at regional and distant sites. At local sites, sensitivity was high, but specificity was lower because of false-positive findings. One fifth of all false-positive PET scans occurred at sites of known inflammation or infection. The area under the curve for a receiver operator characteristic curve on the basis of standardized uptake value (SUV) was 0.882 +/- 0.025. PET interpretation, SUV, and physical examination were independent predictors of relapse-free and overall survival in a time-dependent, multivariate proportional hazards model. An increase in SUV by one unit increased the relative risk (RR) of relapse by 11% and the RR of death by 14%. A positive PET interpretation increased the RR of relapse by four-fold and the RR of death by seven-fold.
PET was a highly sensitive method of detecting recurrent HNSCC and provided important prognostic information for relapse-free and overall survival.
复发性头颈部鳞状细胞癌（HNSCC）患者面临诊断和治疗挑战。我们评估了[（18）F]氟脱氧葡萄糖正电子发射断层扫描（PET）在该患者群体中的诊断准确性和预后价值。
我们对143例先前接受过治疗的HNSCC患者进行了回顾性研究，这些患者于1996年5月至2001年4月在我们机构接受了181次PET扫描以检测疾病复发。将6个月内的疾病复发用作评估PET时真实疾病状态的金标准。
将可疑部位视为阳性时，PET检测复发的总体敏感性和特异性分别为96%和72%。PET在区域和远处部位具有高度敏感性和特异性。在局部部位，敏感性较高，但由于假阳性结果，特异性较低。所有假阳性PET扫描中有五分之一发生在已知炎症或感染部位。基于标准化摄取值（SUV）的受试者操作特征曲线下面积为0.882±0.025。在时间依赖性多变量比例风险模型中，PET解释、SUV和体格检查是无复发生存和总生存的独立预测因素。SUV每增加一个单位，复发的相对风险（RR）增加11%，死亡的RR增加14%。PET解释阳性使复发的RR增加四倍，死亡的RR增加七倍。
PET是检测复发性HNSCC的高度敏感方法，并为无复发生存和总生存提供了重要的预后信息。
