Troeltzsch Matthias, Probst Florian Andreas, Rominger Axel, Müller-Lisse Ulrich, Probst Monika, Obermeier Katharina, Ehrenfeld Michael, Otto Sven
Resident, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
Fellow, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
J Oral Maxillofac Surg. 2018 Jan;76(1):190-198. doi: 10.1016/j.joms.2017.05.024. Epub 2017 May 31.
This study evaluated the role of imaging staging examinations (positron-emission tomographic computed tomography [PET/CT] and contrast-enhanced computed tomography [ceCT]) for the assessment of the comorbidity status of patients with oral squamous cell carcinoma (OSCC). A binary null hypothesis was drafted: 1) imaging staging examinations do not augment knowledge about the comorbidity status of patients with OSCC and 2) there is no difference between PET/CT and ceCT in this regard.
A retrospective cohort study design was selected to address the research question. Patients with histologically confirmed OSCC who underwent whole-body staging by PET/CT or ceCT from 2012 through 2015 were considered for inclusion according to predefined criteria. Data collection was performed by the review of patient charts and histology, radiology, and nuclear medicine reports. The Charlson Comorbidity Index (CCI) was chosen to quantify comorbidity and was calculated before and after staging and then compared. The type of imaging staging examination (PET/CT or ceCT) served as the predictor variable and the CCI was determined as the primary outcome variable. Descriptive and inferential statistics were computed for the variable scale. The significance level was set at a P value less than or equal to .05.
The sample was composed of 178 patients (71 women, 107 men; average age, 64.2 yr) of whom 109 (61%) underwent PET/CT and 69 (39%) underwent ceCT staging. The pre- and post-staging CCI notably differed. Neither imaging technique showed superior results.
Relevant and otherwise covert comorbidities can be found by the performance of imaging staging examinations. This enables clinicians to better assess the peri-therapeutic risk and prognosis of patients with OSCC. Therefore, a detailed evaluation of incidental findings on imaging studies is warranted and recommended.
本研究评估了影像分期检查（正电子发射断层扫描计算机断层扫描[PET/CT]和增强计算机断层扫描[ceCT]）在评估口腔鳞状细胞癌（OSCC）患者合并症状态中的作用。提出了一个二元零假设：1）影像分期检查不会增加对OSCC患者合并症状态的了解；2）在这方面PET/CT和ceCT之间没有差异。
选择回顾性队列研究设计来解决该研究问题。根据预先定义的标准，纳入2012年至2015年期间通过PET/CT或ceCT进行全身分期且组织学确诊为OSCC的患者。通过查阅患者病历以及组织学、放射学和核医学报告来进行数据收集。选择Charlson合并症指数（CCI）来量化合并症，并在分期前后进行计算然后比较。影像分期检查的类型（PET/CT或ceCT）作为预测变量，CCI被确定为主要结局变量。对变量尺度进行描述性和推断性统计。显著性水平设定为P值小于或等于0.05。
样本由178例患者组成（71例女性，107例男性；平均年龄64.2岁），其中109例（61%）接受了PET/CT检查，69例（39%）接受了ceCT分期。分期前后的CCI有显著差异。两种影像技术均未显示出更优结果。
通过进行影像分期检查可以发现相关的以及其他隐匿的合并症。这使临床医生能够更好地评估OSCC患者的围治疗期风险和预后。因此，有必要且建议对影像研究中的偶然发现进行详细评估。
