Awan Musaddiq J, Lavertu Pierre, Zender Chad, Rezaee Rod, Fowler Nicole, Karapetyan Lilit, Gibson Michael, Wasman Jay, Faulhaber Peter, Machtay Mitchell, Yao Min
Department of Radiation Oncology, Case Western Reserve University and University Hospitals, 11100 Euclid Avenue, Cleveland, OH, 44114, USA.
Department of Otolaryngology and Head and Neck Surgery, University Hospitals, Cleveland, OH, USA.
Eur J Nucl Med Mol Imaging. 2017 Jun;44(6):988-997. doi: 10.1007/s00259-016-3612-1. Epub 2017 Jan 14.
To retrospectively review post-treatment (post-tx) FDG-PET/CT scans in patients with advanced head and neck squamous cell carcinoma (HNSCC) and known p16 status, treated with definitive (chemo)radiation (RT).
A total of 108 eligible patients had N2A or greater HNSCC treated with chemoRT from August 1, 2008, to February 28, 2015, with post-tx PET/CT within 6 months after RT. Kaplan-Meier curves, log-rank statistics, and Cox proportional hazards regression were used for statistical analysis.
Median follow-up was 2.38 years. Sixty-eight (63.0%) patients had p16+ and 40 (37.0%) had p16- status. Two-year overall survival and recurrence-free survival were 93.4% and 77.8%, respectively. The negative predictive value (NPV) of PET/CT for local recurrence (LR) was 100%. The NPV for regional recurrence (RR) was 96.5% for all patients, 100% for p16+ patients, and 88.5% for p16- patients. The positive predictive value (PPV) of PET/CT for recurrence was 77.3% for all patients, 50.0% for p16+, and 78.6% for p16-. The PPV for LR was 72.7% for all patients, 50.0% for p16+ patients, and 72.7% for p16- patients. The PPV for RR was 50.0% for all patients, 33% for p16+, and 66.6% for p16-. Post-tx PET/CT and p16 status were independent predictors of recurrence-free survival (p < 0.01).
Post-tx PET/CT predicts treatment outcomes in both p16 + and p16- patients, and does so independently of p16 status. P16- patients with negative PET have a 10% risk of nodal recurrence, and closer follow-up in these patients is warranted.
回顾性分析接受根治性（化疗）放疗的晚期头颈部鳞状细胞癌（HNSCC）且已知p16状态患者的治疗后（post-tx）氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG-PET/CT）结果。
2008年8月1日至2015年2月28日期间，共有108例符合条件的N2A期或更晚期HNSCC患者接受了化疗放疗，并在放疗后6个月内进行了治疗后PET/CT检查。采用Kaplan-Meier曲线、对数秩统计和Cox比例风险回归进行统计分析。
中位随访时间为2.38年。68例（63.0%）患者为p16阳性，40例（37.0%）患者为p16阴性。两年总生存率和无复发生存率分别为93.4%和77.8%。PET/CT对局部复发（LR）的阴性预测值（NPV）为100%。所有患者区域复发（RR）的NPV为96.5%，p16阳性患者为100%，p16阴性患者为88.5%。PET/CT对复发的阳性预测值（PPV）在所有患者中为77.3%，p16阳性患者为50.0%，p16阴性患者为78.6%。所有患者LR的PPV为72.7%，p16阳性患者为50.0%，p16阴性患者为72.7%。所有患者RR的PPV为50.0%，p16阳性患者为33%，p16阴性患者为66.6%。治疗后PET/CT和p16状态是无复发生存的独立预测因素（p＜0.01）。
治疗后PET/CT可预测p16阳性和p16阴性患者的治疗结果，且与p16状态无关。PET阴性的p16阴性患者有10%的淋巴结复发风险，因此有必要对这些患者进行更密切的随访。
