Bisdas Sotirios, Nguyen Shaun A, Anand Sharma K, Glavina Gordana, Day Terry, Rumboldt Zoran
Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA.
Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1313-8. doi: 10.1016/j.ijrobp.2008.06.1956. Epub 2008 Oct 27.
To assess whether pretreatment perfusion computed tomography (PCT) may predict outcome in chemoradiated patients with oral cavity, oropharynx, and hypopharynx squamous cell carcinoma (SCCA) after surgical excision.
Twenty-one patients with SCCA were examined before treatment. The primary site was oral cavity in 6, oropharynx in 7, and hypopharynx in 8 patients; there were 11 T2, 6 T3, and 4 T4 tumors. PCT was performed at the level of largest tumor diameter based on standard neck CT. The data were processed to obtain blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface area product (PS). Regions of interest were free-hand positioned on the lesions to obtain PCT measurements. Tumor volume was also calculated. Follow-up was performed with positron emission tomography (PET)/CT and endoscopy. Pearson correlation coefficient was used for comparison between the subgroups. A regression model was constructed to predict recurrence based on the following predictors: age, gender, tumor (T) and nodal (N) stage, tumor volume, and PCT parameters.
BF(mean), BF(max), BV(mean), BV(max), MTT(mean), PS(mean), and PS(max) were significantly different between patients with and without tumor recurrence (0.0001, p < 0.04). T stage, tumor volume, N stage, BF(max), BV(max), MTT(mean), and radiation dose (p < 0.001) were independent predictors for recurrence. Cox proportional hazards model for tumor recurrence revealed significantly increased risk with high tumor volume (p = 0.00001, relative risk [RR] 7.4), low PS(mean) (p = 0.0001, RR 14.3), and low BF(max) (p = 0.002, RR 5.9).
Our data suggest that PCT parameters have a prognostic role in patients with SCCA.
评估术前灌注计算机断层扫描（PCT）能否预测口腔、口咽和下咽鳞状细胞癌（SCCA）患者接受放化疗后手术切除的预后。
21例SCCA患者在治疗前接受检查。原发部位为口腔6例、口咽7例、下咽8例；有11例T2期、6例T3期和4例T4期肿瘤。根据标准颈部CT在最大肿瘤直径层面进行PCT检查。对数据进行处理以获得血流量（BF）、血容量（BV）、平均通过时间（MTT）和通透表面积乘积（PS）。在病变处徒手定位感兴趣区域以获得PCT测量值。还计算了肿瘤体积。采用正电子发射断层扫描（PET）/CT和内镜进行随访。使用Pearson相关系数在亚组之间进行比较。基于以下预测因素构建回归模型以预测复发：年龄、性别、肿瘤（T）和淋巴结（N）分期、肿瘤体积和PCT参数。
有肿瘤复发和无肿瘤复发患者之间的BF（均值）、BF（最大值）、BV（均值）、BV（最大值）、MTT（均值）、PS（均值）和PS（最大值）存在显著差异（0.0001，p<0.04）。T分期、肿瘤体积、N分期、BF（最大值）、BV（最大值）、MTT（均值）和放射剂量（p<0.001）是复发的独立预测因素。肿瘤复发的Cox比例风险模型显示，高肿瘤体积（p = 0.00001，相对风险[RR]7.4）、低PS（均值）（p = 0.0001，RR 14.3）和低BF（最大值）（p = 0.002，RR 5.9）时风险显著增加。
我们的数据表明，PCT参数在SCCA患者中具有预后作用。
