Jwa Eunjin, Lee Sang-Wook, Kim Jae-Seung, Park Jin Hong, Kim Su Ssan, Kim Young Seok, Yoon Sang Min, Song Si Yeol, Kim Jong Hoon, Choi Eun Kyung, Ahn Seung Do
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Radiat Oncol J. 2012 Dec;30(4):173-81. doi: 10.3857/roj.2012.30.4.173. Epub 2012 Dec 31.
To evaluate the prognostic value of preoperative neck lymph node (LN) assessment with (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), computed tomography (CT), and magnetic resonance imaging (MRI) in oral cavity squamous cell carcinoma (OSCC) patients with pathologically positive LN.
In total, 47 OSCC patients with pathologically positive LN were retrospectively reviewed with preoperative (18)F-FDG PET and CT/MRI. All patients underwent surgical resection, neck dissection and postoperative adjuvant radiotherapy and/or chemotherapy between March 2002 and October 2010. Histologic correlation was performed for findings of (18)F-FDG PET and CT/MRI.
Thirty-six (76.6%) of 47 cases were correctly diagnosed with neck LN metastasis by (18)F-FDG PET and 32 (68.1%) of 47 cases were correctly diagnosed by CT/MRI. Follow-up ranged from 20 to 114 months (median, 56 months). Clinically negative nodal status evaluated by (18)F-FDG PET or CT/MRI revealed a trend toward better clinical outcomes in terms of overall survival, disease-free survival, local recurrence-free survival, regional nodal recurrence-free survival, and distant metastasis-free survival rates even though the trends were not statistically significant. However, there was no impact of neck node standardized uptake value (SUV(max)) on clinical outcomes. Notably, SUV(max) showed significant correlation with tumor size in LN (p < 0.01, R(2) = 0.62). PET and CT/MRI status of LN also had significant correlation with the size of intranodal tumor deposit (p < 0.05, R(2) = 0.37 and p < 0.01, R(2) = 0.48, respectively).
(18)F-FDG PET and CT/MRI at the neck LNs might improve risk stratification in OSCC patients with pathologically positive neck LN in this study, even without significant prognostic value of SUV(max).
评估术前颈部淋巴结（LN）评估中，¹⁸F - 氟脱氧葡萄糖正电子发射断层扫描（¹⁸F - FDG PET）、计算机断层扫描（CT）和磁共振成像（MRI）对口腔鳞状细胞癌（OSCC）病理确诊颈部淋巴结阳性患者的预后价值。
回顾性分析47例病理确诊颈部淋巴结阳性的OSCC患者术前¹⁸F - FDG PET及CT/MRI检查结果。所有患者在2002年3月至2010年10月期间接受了手术切除、颈部清扫及术后辅助放疗和/或化疗。对¹⁸F - FDG PET及CT/MRI检查结果进行组织学相关性分析。
47例患者中，¹⁸F - FDG PET正确诊断颈部淋巴结转移36例（76.6%），CT/MRI正确诊断32例（68.1%）。随访时间为20至114个月（中位时间56个月）。¹⁸F - FDG PET或CT/MRI评估临床淋巴结阴性状态，在总生存率、无病生存率、局部无复发生存率、区域淋巴结无复发生存率和远处转移无复发生存率方面显示出临床结局更好的趋势，尽管这些趋势无统计学意义。然而，颈部淋巴结标准化摄取值（SUV(max)）对临床结局无影响。值得注意的是，SUV(max)与淋巴结内肿瘤大小显著相关（p < 0.01，R² = 0.62）。PET和CT/MRI的淋巴结状态也与淋巴结内肿瘤沉积大小显著相关（分别为p < 0.05，R² = 0.37和p < 0.01，R² = 0.48）。
在本研究中，¹⁸F - FDG PET和颈部淋巴结的CT/MRI检查可能改善病理确诊颈部淋巴结阳性的OSCC患者的风险分层分析，即便SUV(max)无显著预后价值。
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