1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
AJR Am J Roentgenol. 2014 Apr;202(4):851-8. doi: 10.2214/AJR.13.11013.
The purpose of this study was to determine whether pretreatment quantitative and visual parameters seen on PET/CT using (18)F-FDG add prognostic information for clinical staging in patients with head and neck cancer.
We enrolled 108 patients with histologically proven oral, oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinomas who underwent FDG PET/CT before treatment and, later, definitive therapy in our study. PET/CT parameters-maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and uptake pattern (sphere-shaped or ring-shaped)-were recorded. The prognostic value of these parameters was evaluated using univariate and multivariate Cox regression analyses.
In the univariate analysis, all of the FDG PET/CT parameters--SUVmax (> 10 g/mL) of the primary tumor, MTV (> 20 cm(3)), TLG (> 70 g), and uptake pattern (ring-shaped)--were significantly associated with negative effects on disease-specific survival (DSS) and disease-free survival (DFS). In the multivariate analysis, the MTV and uptake pattern remained associated with DSS after corrections for the Union for International Cancer Control (UICC) stage and definitive therapy (p = 0.023 and < 0.001, respectively). Another multivariate model that included MTV as a continuous variable, uptake pattern, and UICC stage showed that the uptake pattern remained significantly associated with DSS, whereas the association between DSS and MTV was not significant (p < 0.001 and = 0.332, respectively).
Our data indicate that the pretreatment PET/CT parameters had prognostic value. In particular, a qualitative factor, uptake pattern, provided better prognostic information to the clinical staging of head and neck squamous cell carcinomas than the other PET/CT parameters.
本研究旨在确定（18）F-FDG 摄取的 PET/CT 定量和视觉参数是否能为头颈部癌症患者的临床分期提供预后信息。
我们纳入了 108 例经组织学证实的口腔、口咽、下咽和喉鳞状细胞癌患者，这些患者在治疗前和随后的根治性治疗中均接受了 FDG PET/CT 检查。记录了 PET/CT 参数（最大标准化摄取值 [SUVmax]、代谢肿瘤体积 [MTV]、总肿瘤糖酵解 [TLG]和摄取模式（球形或环形）。采用单变量和多变量 Cox 回归分析评估这些参数的预后价值。
在单变量分析中，原发肿瘤 SUVmax（>10 g/ml）、MTV（>20 cm3）、TLG（>70 g）和摄取模式（环形）等所有 FDG PET/CT 参数均与疾病特异性生存率（DSS）和无病生存率（DFS）呈负相关。在多变量分析中，校正国际抗癌联盟（UICC）分期和根治性治疗后，MTV 和摄取模式仍与 DSS 相关（p=0.023 和<0.001）。另一个包含 MTV 为连续变量、摄取模式和 UICC 分期的多变量模型显示，摄取模式与 DSS 仍显著相关，而 MTV 与 DSS 之间的相关性不显著（p<0.001 和=0.332）。
我们的数据表明，预处理 PET/CT 参数具有预后价值。特别是，摄取模式作为一种定性因素，比其他 PET/CT 参数为头颈部鳞状细胞癌的临床分期提供了更好的预后信息。
