Department of Otolaryngology - Head and Neck Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
Int J Clin Oncol. 2013 Jun;18(3):402-10. doi: 10.1007/s10147-012-0393-9. Epub 2012 Mar 9.
The purpose of this study was to investigate the possibility of early survival prediction after completion of one cycle of neoadjuvant chemotherapy (NAC) by positron emission tomography (PET)/computed tomography (CT) with (18)F-fluorodeoxyglucose (FDG).
Fifty-seven patients with advanced head and neck squamous cell carcinoma (HNSCC) underwent FDG-PET/CT scans twice, before and after one cycle of NAC. We calculated the maximal standardized uptake value (SUV(max)) for a primary tumor and/or metastatic lymph nodes and defined %decrease as the %difference in SUV(max) between the two scans divided by that of the initial scan. Patients were classified as responders by PET (%decrease ≥55.5% or post-NAC SUV(max) ≤3.5) and by RECIST (≥30% decrease in size). The local control (LC) rate and the disease-specific survival (DSS) rate were assessed between the responders and non-responders. Multivariate analysis was also performed using the Cox proportional hazards model.
In univariate analysis, the PET finding of a primary site was a significant risk factor for LC and DSS rates at 2 years after completion of NAC (P = 0.03 and 0.02, respectively), but there was no difference between responders and non-responders by the RECIST criteria. In a multivariate regression analysis, the PET finding in the primary site and the definitive therapy choice were independent prognostic factors in LC, while the PET finding in the primary site was the only independent prognostic factor in DSS.
Our preliminary data indicate that the PET finding in the primary lesion after one cycle of NAC was an independent prognostic factor in LC and DSS in patients with HNSCC.
本研究旨在通过正电子发射断层扫描（PET）/计算机断层扫描（CT）用（18）F-氟脱氧葡萄糖（FDG）来探讨在完成一个周期新辅助化疗（NAC）后早期预测生存的可能性。
57 例晚期头颈部鳞状细胞癌（HNSCC）患者在接受 NAC 前后进行了两次 FDG-PET/CT 扫描。我们计算了原发肿瘤和/或转移性淋巴结的最大标准化摄取值（SUV(max))，并将 %decrease 定义为两次扫描之间 SUV(max)的差异除以初始扫描的 SUV(max)。患者根据 PET（%decrease≥55.5%或 post-NAC SUV(max)≤3.5）和 RECIST（肿瘤大小至少减少 30%）被分为应答者。在应答者和非应答者之间评估局部控制（LC）率和疾病特异性生存（DSS）率。还使用 Cox 比例风险模型进行了多变量分析。
在单因素分析中，原发灶的 PET 结果是 NAC 完成后 2 年 LC 和 DSS 率的显著危险因素（分别为 P=0.03 和 0.02），但根据 RECIST 标准，应答者和非应答者之间没有差异。在多变量回归分析中，原发灶的 PET 结果和明确治疗选择是 LC 的独立预后因素，而原发灶的 PET 结果是 DSS 的唯一独立预后因素。
我们的初步数据表明，NAC 后一个周期原发灶的 PET 结果是 HNSCC 患者 LC 和 DSS 的独立预后因素。
