Jeong Yuri, Baek Seunghee, Park Jae W, Joo Ji H, Kim Jae S, Lee Sang-Wook
1 Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
2 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
Br J Radiol. 2017 Mar;90(1071):20160239. doi: 10.1259/bjr.20160239. Epub 2016 Dec 23.
The aim of the present study was to evaluate prognostic values of pre-treatment fluorine-18 fludeoxyglucose (F-FDG) positron emission tomography (PET) parameters for predicting the distant metastasis (DM) of nasopharyngeal cancer.
73 patients diagnosed with nasopharyngeal cancer with regional lymph node (LN) involvement, who underwent pre-treatment F-FDG PET evaluation between January 2005 and December 2012, were retrospectively reviewed. We assessed the F-FDG PET parameters of the primary tumours (T-) and regional LNs (N-). For patients with bilateral retropharyngeal, bilateral neck and/or supraclavicular LN involvement, we also assessed the F-FDG PET parameters of the farthest LN station [N(f)-]. The following F-FDG PET parameters were evaluated: maximum standardized uptake value (SUV), mean standardized uptake value (SUV), peak standardized uptake value (SUV), metabolic tumour volumes (MTVs) (MTV-MTV, which were calculated as the tumour volume with 30%, 40%, 50%, 60% and 70% of the SUV as the threshold, respectively) and total lesion glycolysis (TLG) (TLG-TLG, which were determined by the product of each MTV and the corresponding SUV within that MTV). Distant metastasis-free survival (DMFS) rates were estimated from the date of the start of radiotherapy to the date of DM or last follow-up by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify prognostic factors for DMFS. The median follow-up period was 53 months (range 12-110 months).
Most patients (95%) received concurrent chemoradiotherapy. The major failure pattern was DM (15 of all patients, 21%) and the 5-year DMFS was 79%. In univariate analysis, the T-SUV, T-SUV, T-SUV, N-SUV, N-SUV, N(f)-SUV and N(f)-SUV were significant prognostic factors for DMFS. In multivariate analysis, the T-SUV, T-SUV, N(f)-SUV and N(f)-SUV were significant prognostic factors for DMFS. Of these parameters, the N(f)-SUV (hazard ratio = 6.524; p = 0.001) and N(f)-SUV (hazard ratio = 5.399; p = 0.001) were the strongest prognostic factors for DMFS.
In patients with nasopharyngeal cancer with LN involvement, the standardized uptake value parameter of the farthest LN station seems to be an important F-FDG PET parameter for predicting DM. Further studies are needed to validate its clinical significance. Advances in knowledge: We found that pre-treatment F-FDG PET parameters of primary tumours and regional LNs (the SUV and SUV of the primary tumour and the farthest LN station) were significant prognostic factors for DMFS in patients with nasopharyngeal carcinoma with LN involvement.
本研究旨在评估治疗前氟代脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）参数对预测鼻咽癌远处转移（DM）的预后价值。
回顾性分析2005年1月至2012年12月期间73例诊断为鼻咽癌且有区域淋巴结（LN）受累并接受治疗前F-FDG PET评估的患者。我们评估了原发肿瘤（T-）和区域LN（N-）的F-FDG PET参数。对于双侧咽后、双侧颈部和/或锁骨上LN受累的患者，我们还评估了最远LN站[N(f)-]的F-FDG PET参数。评估了以下F-FDG PET参数：最大标准化摄取值（SUV）、平均标准化摄取值（SUV）、峰值标准化摄取值（SUV）、代谢肿瘤体积（MTV）（MTV-MTV，分别以SUV的30%、40%、50%、60%和70%为阈值计算肿瘤体积）和总病变糖酵解（TLG）（TLG-TLG，由每个MTV与其内相应SUV的乘积确定）。从放疗开始日期至DM日期或最后随访日期，采用Kaplan-Meier法估计无远处转移生存期（DMFS）率。进行单因素和多因素分析以确定DMFS的预后因素。中位随访期为53个月（范围12 - 110个月）。
大多数患者（95%）接受了同步放化疗。主要失败模式为DM（所有患者中的15例，21%），5年DMFS为79%。在单因素分析中，T-SUV、T-SUV、T-SUV、N-SUV、N-SUV、N(f)-SUV和N(f)-SUV是DMFS的显著预后因素。在多因素分析中，T-SUV、T-SUV、N(f)-SUV和N(f)-SUV是DMFS的显著预后因素。在这些参数中，N(f)-SUV（风险比 = 6.524；p = 0.001）和N(f)-SUV（风险比 = 5.399；p = 0.001）是DMFS最强的预后因素。
在有LN受累的鼻咽癌患者中，最远LN站的标准化摄取值参数似乎是预测DM的重要F-FDG PET参数。需要进一步研究以验证其临床意义。知识进展：我们发现原发肿瘤和区域LN的治疗前F-FDG PET参数（原发肿瘤和最远LN站的SUV和SUV）是有LN受累的鼻咽癌患者DMFS的显著预后因素。
