Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain.
Nuclear Medicine Department, Cruces University Hospital, Barakaldo, Spain.
Clin Transl Oncol. 2017 Nov;19(11):1337-1349. doi: 10.1007/s12094-017-1674-6. Epub 2017 May 24.
PURPOSE/OBJECTIVES: To evaluate the prognostic impact of maximum standardized uptake value (SUV) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing pretreatment [F-18] fluoro-D-glucose-positron emission tomography/computed tomography (FDG PET/CT) imaging.
MATERIALS/METHODS: Fifty-eight patients undergoing FDG PET/CT before radical treatment with definitive radiotherapy (±concomitant chemotherapy) or surgery + postoperative (chemo)radiation were analyzed. The effects of clinicopathological factors (age, gender, tumor location, stage, Karnofsky Performance Status (KPS), and treatment strategy) including primary tumor SUV and nodal SUV on overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) were evaluated. Kaplan-Meier survival curves were generated and compared with the log-rank test.
Median follow-up for the whole population was 31 months (range 2.3-53.5). Two-year OS, LRC, DFS and DMFS, for the entire cohort were 62.1, 78.3, 55.2 and 67.2%, respectively. Median pretreatment SUV for the primary tumor and lymph nodes was 11.85 and 5.4, respectively. According to univariate analysis, patients with KPS < 80% (p < 0.001), AJCC stage IVa or IVb vs III (p = 0.037) and patients undergoing radiotherapy vs surgery (p = 0.042) were significantly associated with worse OS. Patients with KPS < 80% (p = 0.003) or age ≥65 years (p = 0.007) had worse LRC. The KPS < 80% was the only factor associated with decreased DFS (p = 0.001). SUV of the primary tumor or the lymph nodes were not associated with OS, DFS or LRC. The KPS < 80% (p = 0.002), tumor location (p = 0.047) and AJCC stage (p = 0.025) were associated with worse cancer-specific survival (CSS). According to Cox regression analysis, on multivariate analysis KPS < 80% was the only independent parameter determining worse OS, DFS, CSS. Regarding LRC only patients with IK < 80% (p = 0.01) and ≥65 years (p = 0.01) remained statistically significant. Nodal SUV was the only factor associated with decreased DMFS. Patients with a nodal SUV > 5.4 presented an increased risk for distant metastases (HR, 3.3; 95% CI 1.17-9.25; p = 0.023).
The pretreatment nodal SUV in patients with locally advanced HNSCC is prognostic for DMFS. However, according to our results primary tumor SUV and nodal SUV were not significantly related to OS, DFS or LRC. Patients presenting KPS < 80% had worse OS, DFS, CSS and LRC.
评估局部晚期头颈部鳞状细胞癌（HNSCC）患者在进行预处理[F-18]氟代-D-葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）成像前最大标准化摄取值（SUV）的预后影响。
分析了 58 例接受根治性放疗（±同期化疗）或手术+术后（放化疗）治疗的患者的 FDG PET/CT 检查。评估了临床病理因素（年龄、性别、肿瘤部位、分期、卡诺夫斯基表现状态（KPS）和治疗策略）包括原发肿瘤 SUV 和淋巴结 SUV 对总生存期（OS）、无病生存期（DFS）、局部区域控制（LRC）和远处无转移生存期（DMFS）的影响。生成 Kaplan-Meier 生存曲线，并通过对数秩检验进行比较。
全人群的中位随访时间为 31 个月（范围 2.3-53.5）。整个队列的 2 年 OS、LRC、DFS 和 DMFS 分别为 62.1%、78.3%、55.2%和 67.2%。原发肿瘤和淋巴结的预处理 SUV 中位数分别为 11.85 和 5.4。根据单因素分析，KPS<80%（p<0.001）、AJCC 分期 IVa 或 IVb 与 III 期（p=0.037）以及接受放疗与手术（p=0.042）的患者与 OS 较差显著相关。KPS<80%（p=0.003）或年龄≥65 岁（p=0.007）的患者 LRC 较差。KPS<80%是唯一与降低 DFS 相关的因素（p=0.001）。原发肿瘤或淋巴结的 SUV 与 OS、DFS 或 LRC 均无相关性。KPS<80%（p=0.002）、肿瘤部位（p=0.047）和 AJCC 分期（p=0.025）与较差的癌症特异性生存（CSS）相关。根据 Cox 回归分析，多因素分析显示 KPS<80%是影响 OS、DFS 和 CSS 的唯一独立因素。关于 LRC，仅 IK<80%（p=0.01）和≥65 岁（p=0.01）的患者仍然具有统计学意义。淋巴结 SUV 是唯一与 DMFS 降低相关的因素。淋巴结 SUV>5.4 的患者发生远处转移的风险增加（HR，3.3；95%CI，1.17-9.25；p=0.023）。
局部晚期 HNSCC 患者的预处理淋巴结 SUV 与 DMFS 相关。然而，根据我们的结果，原发肿瘤 SUV 和淋巴结 SUV 与 OS、DFS 或 LRC 无显著相关性。KPS<80%的患者 OS、DFS、CSS 和 LRC 较差。
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