Ren Yun-Yan, Li You-Cai, Wu Hu-Bing, Wang Quan-Shi, Han Yan-Jiang, Zhou Wen-Lan, Li Hong-Sheng
Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Eur J Radiol. 2017 Apr;89:200-207. doi: 10.1016/j.ejrad.2017.02.002. Epub 2017 Feb 9.
Although whole-body fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) (F-FDG PET/CT) is commonly used for M staging of newly diagnosed nasopharyngeal carcinoma (NPC), some patients may not benefit from this procedure. The present study investigated which patients require this modality for M staging.
Whole-body F FDG PET/CT results and clinical data were collected for 264 patients with newly diagnosed NPC. The relationships between distant metastasis and age, gender, pathological type, lesion size, SUVmax-T, T staging, N staging, SUVmax-N and Epstein-Barr virus (EBV) quantity were retrospectively analysed to identify factors associated with increased risk.
Of the 264 patients, only 37 (14.0%) were diagnosed with distant metastasis. Using multiple logistic regression analysis, EBV-positivity (OR=13.1; 95% CI:1.61,106.80), N staging (OR=3.05; 95% CI:1.41,6.63) and T staging (OR=2.16; 95% CI:1.10, 4.24) were significantly related to distant metastasis (all P<0.05). EBV DNA levels≥9000copies/ml, N3 stage and T4 stage were identified as high risk factors. A low risk of distant metastasis was found in patients with 0-1 risk factors and in those with 2 specific risk factors, T3/T4 and N2/N3 staging. Patients with EBV DNA levels ≥9000copies/ml and N3 or T4 staging and those with 3 risk factors had a medium or high risk, with a much higher incidence of distant metastasis (χ=29.896, P=0.000), and needed a whole-body F FDG PET/CT for M staging.
Due to the low incidence of distant metastasis, only patients with medium or high risk need to undergo a whole-body scan.
尽管全身氟-18氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）（F-FDG PET/CT）常用于新诊断鼻咽癌（NPC）的M分期，但部分患者可能无法从此检查中获益。本研究调查了哪些患者需要采用此方法进行M分期。
收集264例新诊断NPC患者的全身F-FDG PET/CT结果及临床资料。回顾性分析远处转移与年龄、性别、病理类型、病变大小、SUVmax-T、T分期、N分期、SUVmax-N和EB病毒（EBV）数量之间的关系，以确定与风险增加相关的因素。
264例患者中，仅37例（14.0%）被诊断为远处转移。采用多因素logistic回归分析，EBV阳性（OR=13.1；95%CI：1.61，106.80）、N分期（OR=3.05；95%CI：1.41，6.63）和T分期（OR=2.16；95%CI：1.10，4.24）与远处转移显著相关（均P<0.05）。EBV DNA水平≥9000拷贝/ml、N3期和T4期被确定为高危因素。0-1个危险因素以及具有2个特定危险因素（T3/T4和N2/N3分期）的患者远处转移风险较低。EBV DNA水平≥9000拷贝/ml且N3或T4分期以及具有3个危险因素的患者具有中度或高度风险，远处转移发生率更高（χ=29.896，P=0.000），需要进行全身F-FDG PET/CT以进行M分期。
由于远处转移发生率较低，仅中度或高度风险的患者需要进行全身扫描。
