Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1514-20. doi: 10.1016/j.ijrobp.2011.10.023. Epub 2012 Jan 21.
We have previously reported that metabolic tumor volume (MTV) obtained from pretreatment (18)F-fluorodeoxydeglucose positron emission tomography (FDG PET)/ computed tomography (CT) predicted outcome in patients with head-and-neck cancer (HNC). The purpose of this study was to validate these results on an independent dataset, determine whether the primary tumor or nodal MTV drives this correlation, and explore the interaction with p16(INK4a) status as a surrogate marker for human papillomavirus (HPV).
The validation dataset in this study included 83 patients with squamous cell HNC who had a FDG PET/CT scan before receiving definitive radiotherapy. MTV and maximum standardized uptake value (SUV(max)) were calculated for the primary tumor, the involved nodes, and the combination of both. The primary endpoint was to validate that MTV predicted progression-free survival and overall survival. Secondary analyses included determining the prognostic utility of primary tumor vs. nodal MTV.
Similarly to our prior findings, an increase in total MTV of 17 cm(3) (difference between the 75th and 25th percentiles) was associated with a 2.1-fold increase in the risk of disease progression (p = 0.0002) and a 2.0-fold increase in the risk of death (p = 0.0048). SUV(max) was not associated with either outcome. Primary tumor MTV predicted progression-free (hazard ratio [HR] = 1.94; p < 0.0001) and overall (HR = 1.57; p < 0.0001) survival, whereas nodal MTV did not. In addition, MTV predicted progression-free (HR = 4.23; p < 0.0001) and overall (HR = 3.21; p = 0.0029) survival in patients with p16(INK4a)-positive oropharyngeal cancer.
This study validates our previous findings that MTV independently predicts outcomes in HNC. MTV should be considered as a potential risk-stratifying biomarker in future studies of HNC.
我们之前报道过，头颈部癌症（HNC）患者治疗前 18F-氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）/计算机断层扫描（CT）获得的代谢肿瘤体积（MTV）可预测其预后。本研究的目的是在独立数据集上验证这些结果，确定是原发肿瘤还是淋巴结 MTV 驱动这种相关性，并探索其与 p16（INK4a）状态的相互作用，p16（INK4a）状态是人类乳头瘤病毒（HPV）的替代标志物。
本研究的验证数据集包括 83 例接受根治性放疗的鳞状细胞 HNC 患者，他们在治疗前进行了 FDG PET/CT 扫描。计算了原发肿瘤、受累淋巴结和两者的 MTV 和最大标准化摄取值（SUV(max)）。主要终点是验证 MTV 是否可预测无进展生存期和总生存期。次要分析包括确定原发肿瘤与淋巴结 MTV 的预后效用。
与我们之前的研究结果相似，总 MTV 增加 17 cm3（第 75 百分位数和第 25 百分位数之间的差值）与疾病进展风险增加 2.1 倍（p = 0.0002）和死亡风险增加 2.0 倍（p = 0.0048）相关。SUV(max)与任何结果均无关。原发肿瘤 MTV 预测无进展生存期（风险比 [HR] = 1.94；p < 0.0001）和总生存期（HR = 1.57；p < 0.0001），而淋巴结 MTV 则不然。此外，MTV 预测了 p16（INK4a）阳性口咽癌患者的无进展生存期（HR = 4.23；p < 0.0001）和总生存期（HR = 3.21；p = 0.0029）。
本研究验证了我们之前的发现，即 MTV 可独立预测 HNC 的预后。MTV 应被视为未来 HNC 研究中的一种潜在风险分层生物标志物。
