Jin Ya-Nan, Yao Ji-Jin, Wang Si-Yang, Zhang Wang-Jian, Zhou Guan-Qun, Zhang Fan, Cheng Zhi-Bin, Ma Jun, Mo Hao-Yuan, Sun Ying
1 Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
2 Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
Tumour Biol. 2017 Jul;39(7):1010428317717843. doi: 10.1177/1010428317717843.
Distant metastasis has become the predominant model of treatment failures in patients with locoregionally advanced nasopharyngeal carcinoma. Effort should therefore be made to stratify locoregionally advanced nasopharyngeal carcinoma patients into different groups based on the risk of metastasis to improve prognosis and tailor individualized treatments. This study aims to assess the value of primary gross tumor volume and the maximum standardized uptake value for predicting distant metastasis-free survival of patients with locoregionally advanced nasopharyngeal carcinoma. A total of 294 locoregionally advanced nasopharyngeal carcinoma patients who were identified from prospectively maintained database and underwent fluor-18-fluorodeoxyglucose positron emission tomography/computed tomography imaging before treatment were included. The maximum standardized uptake value was recorded for the primary tumor (SUVmax-P) and neck lymph nodes (SUVmax-N). Computed tomography-derived primary gross tumor volume was measured using the summation-of-area technique. At 5 years, the distant metastasis-free survival rate was 83.7%. The cut-off of the SUVmax-P, SUVmax-N, and primary gross tumor volume for distant metastasis-free survival was 8.95, 5.75, and 31.3 mL, respectively, by receiver operating characteristic curve. In univariate analysis, only SUVmax-N (hazard ratio: 7.01; 95% confidence interval: 1.70-28.87; p < 0.01) and clinical stage (hazard ratio: 3.03; 95% confidence interval: 1.67-5.47; p = 0.007) were confirmed as independent predictors of distant metastasis-free survival. A prognostic model was derived by SUVmax-N and clinical stage: low risk (SUVmax-N < 5.75 regardless of clinical stage), medium risk (stage III and SUVmax-N ≥ 5.75), and high risk (stage IV and SUVmax-N ≥ 5.75). Multivariate analysis revealed that SUVmax-N and the prognostic model remained independent prognostic factors for distant metastasis-free survival (p = 0.023 and p < 0.001, respectively), but the clinical stage became insignificant (p = 0.133). Furthermore, the adjusted hazard ratios for the prognostic model were higher than SUVmax-N (hazard ratio = 6.27 vs 5.21, respectively). In summary, compared with SUVmax-P, SUVmax-N may be a better predictor of distant metastasis-free survival for patients with locoregionally advanced nasopharyngeal carcinoma. Combining SUVmax-N with clinical stage gives a more precise picture in predicting distant metastasis.
远处转移已成为局部区域晚期鼻咽癌患者治疗失败的主要模式。因此，应努力根据转移风险将局部区域晚期鼻咽癌患者分层为不同组，以改善预后并制定个体化治疗方案。本研究旨在评估原发大体肿瘤体积和最大标准化摄取值对预测局部区域晚期鼻咽癌患者无远处转移生存期的价值。共纳入294例从前瞻性维护数据库中识别出的局部区域晚期鼻咽癌患者，这些患者在治疗前接受了氟-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描成像。记录原发肿瘤（SUVmax-P）和颈部淋巴结（SUVmax-N）的最大标准化摄取值。使用面积求和技术测量计算机断层扫描得出的原发大体肿瘤体积。5年时，无远处转移生存率为83.7%。通过受试者工作特征曲线，无远处转移生存期的SUVmax-P、SUVmax-N和原发大体肿瘤体积的截断值分别为8.95、5.75和31.3 mL。单因素分析中，仅SUVmax-N（风险比：7.01；95%置信区间：1.70 - 28.87；p < 0.01）和临床分期（风险比：3.03；95%置信区间：1.67 - 5.47；p = 0.007）被确认为无远处转移生存期的独立预测因素。通过SUVmax-N和临床分期得出一个预后模型：低风险（无论临床分期如何，SUVmax-N < 5.75）、中风险（III期且SUVmax-N≥5.75）和高风险（IV期且SUVmax-N≥5.75）。多因素分析显示，SUVmax-N和预后模型仍然是无远处转移生存期的独立预后因素（分别为p = 0.023和p < 0.001），但临床分期变得不显著（p = 0.133）。此外，预后模型的调整后风险比高于SUVmax-N（风险比分别为6.27和5.21）。总之，与SUVmax-P相比，SUVmax-N可能是局部区域晚期鼻咽癌患者无远处转移生存期的更好预测指标。将SUVmax-N与临床分期相结合在预测远处转移方面能提供更精确的情况。
