Lin Huan-Chun, Kang Chung-Jan, Huang Shiang-Fu, Wang Hung-Ming, Lin Chien-Yu, Lee Li-Yu, Liao Chun-Ta, Yen Tzu-Chen
Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China.
Eur J Nucl Med Mol Imaging. 2017 Sep;44(10):1702-1711. doi: 10.1007/s00259-017-3713-5. Epub 2017 May 26.
This single-center retrospective study of prospectively collected data was aimed at comparing the clinical outcomes of positron emission tomography/computed tomography (PET/CT) for patients with oral cavity squamous cell carcinoma (OSCC) with symptomatic recurrences identified by PET/CT imaging following adjuvant therapy (Group A) versus those of cases with asymptomatic recurrences diagnosed through periodic post-adjuvant therapy PET/CT surveillance (Group B). We also sought to establish the priority of salvage therapy in the two study groups.
We identified 111 patients with advanced resected OSCC who developed recurrences following adjuvant therapy (51 in Group A and 60 in Group B). Histopathology served as the gold standard for recurrent lesions. The impact of post-adjuvant therapy PET/CT surveillance was examined with Kaplan-Meier curves and Cox proportional hazards regression models.
The 2-year DSS and OS rates were marginally or significantly higher in Group B than in Group A (P = 0.073 and P = 0.025, respectively). Time-dependent ROC curve analysis demonstrated that the optimal cutoff values for time to positive PET/CT findings in relation to OS were 12 months for Group A and 9 months for Group B, respectively. Independent risk factors identified in multivariate analyses were used to devise two prognostic scoring systems for 2-year DSS and OS in each study group (all P < 0.001).
Scheduled periodic PET/CT surveillance is a valuable tool for early detection of recurrent lesion(s) in asymptomatic OSCC patients who bear risk factors for disease recurrence. The presence of clinical symptoms and a short time to positive PET/CT findings were adverse prognostic factors for clinical outcome in patients with advanced OSCC. The priority of salvage therapy is discussed in each patient subgroup according to the devised prognostic scoring systems.
本项对前瞻性收集数据的单中心回顾性研究旨在比较正电子发射断层扫描/计算机断层扫描（PET/CT）对口腔鳞状细胞癌（OSCC）患者的临床结局，这些患者在辅助治疗后出现症状性复发（A组），以及通过辅助治疗后定期PET/CT监测诊断出的无症状复发患者（B组）。我们还试图确定两个研究组挽救治疗的优先级。
我们确定了111例接受根治性切除的晚期OSCC患者，他们在辅助治疗后出现复发（A组51例，B组60例）。组织病理学是复发病变的金标准。采用Kaplan-Meier曲线和Cox比例风险回归模型检验辅助治疗后PET/CT监测的影响。
B组的2年无病生存率（DSS）和总生存率（OS）略高于或显著高于A组（分别为P = 0.073和P = 0.025）。时间依赖性ROC曲线分析表明，A组和B组与OS相关的PET/CT阳性结果出现时间的最佳截断值分别为12个月和9个月。多变量分析中确定的独立危险因素用于为每个研究组的2年DSS和OS设计两个预后评分系统（所有P < 0.001）。
定期进行PET/CT监测是早期发现有疾病复发危险因素的无症状OSCC患者复发病变的有价值工具。临床症状的出现和PET/CT阳性结果出现时间短是晚期OSCC患者临床结局的不良预后因素。根据设计的预后评分系统，在每个患者亚组中讨论挽救治疗的优先级。
