Kunkel Martin, Förster Gregor J, Reichert Torsten E, Jeong Jong-Hyeon, Benz Peter, Bartenstein Peter, Wagner Wilfried, Whiteside Theresa L
Department of Oral and Maxillofacial Surgery, University Hospital Mainz, Mainz, Germany.
Cancer. 2003 Nov 15;98(10):2257-65. doi: 10.1002/cncr.11763.
Patients with recurrent oral squamous cell carcinoma (OSCC) have a dismal prognosis and represent a therapeutic challenge. A positron emission tomography (PET) scan with [(18)F]-2-fluorodeoxyglucose ([(18)F]FDG) can improve early cancer detection. The current study evaluates the prognostic value of [(18)F]FDG-PET scan in patients with recurrent OSCC.
The authors studied 97 patients with previously resected OSCC who were restaged by PET scanning. Of the 97 patients, 64 had no evidence of clinical disease and 33 were suspected of having disease by imaging, clinical findings, or pathologic evaluation. The median follow-up period was 35.4 months after a PET scan. The end points included disease recurrence, a disease recurrence-free period 6 months after a PET scan, or death.
The overall sensitivity of a PET scan did not exceed 90% and its specificity varied from 67% for local disease recurrence/second primaries to 99% for lymph node metastasis. Increased [(18)F]FDG uptake predicted increased hazard of death (hazard ratio: 6.83; P = 0.00034) and proved to be a highly predictive marker of disease status. A significant association was established for incremental standardized uptake values and 3-year patient survival (P=0.0089), indicating that intense glucose metabolism in the tumor is a negative marker of survival in recurrent OSCC. Overall, survival was longer in patients with a negative rather than a positive PET scan (P < 0.00001).
PET scanning was found to be highly valuable for diagnosing OSCC recurrence in a postoperative setting. It provided prognostic information and played an important role in patient counseling and management.
复发性口腔鳞状细胞癌（OSCC）患者预后不佳，是一个治疗难题。采用[（18）F]-2-氟脱氧葡萄糖（[（18）F]FDG）进行正电子发射断层扫描（PET）可改善癌症的早期检测。本研究评估了[（18）F]FDG-PET扫描对复发性OSCC患者的预后价值。
作者研究了97例先前已接受手术切除的OSCC患者，这些患者通过PET扫描重新分期。97例患者中，64例无临床疾病证据，33例经影像学、临床检查或病理评估怀疑患有疾病。PET扫描后的中位随访期为35.4个月。终点指标包括疾病复发、PET扫描后6个月的无疾病复发期或死亡。
PET扫描的总体敏感性不超过90%，其特异性因情况而异，局部疾病复发/第二原发肿瘤的特异性为67%，淋巴结转移的特异性为99%。[（18）F]FDG摄取增加预示死亡风险增加（风险比：6.83；P = 0.00034），并被证明是疾病状态的高度预测指标。标准化摄取值增加与患者3年生存率之间存在显著关联（P = 0.0089），表明肿瘤中强烈的葡萄糖代谢是复发性OSCC患者生存的负面指标。总体而言，PET扫描阴性患者的生存期长于阳性患者（P < 0.00001）。
发现PET扫描对术后诊断OSCC复发具有很高的价值。它提供了预后信息，并在患者咨询和管理中发挥了重要作用。
