Nuclear Medicine and Molecular Imaging Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan; Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan.
Oral Oncol. 2018 Mar;78:156-162. doi: 10.1016/j.oraloncology.2018.01.030. Epub 2018 Feb 20.
Human papillomavirus-negative oropharyngeal squamous cell carcinoma (OPSCC) has unfavorable survival outcomes. Two outcomes have been identified based on smoking history and tumor stage. We investigate the prognostic role of pre-treatment positron emission tomography (PET) in high-risk OPSCC.
We enrolled 147 M0 OPSCC patients with p16-negative staining and a history of heavy smoking (>10 pack-years) or T4 disease. All patients completed primary chemoradiotherapy, and 42% maximum standard uptake values (SUV) were used as the threshold for primary tumor. Patients were classified into training and validation cohorts with a ratio of 1:1.5 according to the PET date. Heterogeneity and irregularity indices were obtained. PET parameters with significant impact on progression-free survival (PFS) in receiver operating characteristic curves and univariate Cox models were identified and included in recursive partitioning analysis (RPA) for constructing a prognostic model. The RPA-based prognostic model was further tested in the validation cohort using multivariate Cox models.
Fifty-eight and 89 patients were in the training and validation groups, respectively. Heterogeneity parameter, SUV-entropy (derived from histogram analysis), and irregularity index, and asphericity were significantly associated with PFS. The RPA model revealed that patients with both high SUV-entropy and high asphericity experienced the worst PFS. Results were confirmed in the validation group. The overall concordance index for PFS of the model was 0.75, which was higher than the clinical stages, performance status, SUV, and metabolic tumor volume of PET.
PET prognostic model provided useful prediction of PFS for patients with high-risk OPSCC.
人乳头瘤病毒阴性口咽鳞状细胞癌（OPSCC）的生存预后较差。根据吸烟史和肿瘤分期，可将其分为两种结果。我们研究了治疗前正电子发射断层扫描（PET）在高危 OPSCC 中的预后作用。
我们纳入了 147 例 p16 阴性且有重度吸烟史（>10 包/年）或 T4 期疾病的 M0 OPSCC 患者。所有患者均接受了根治性放化疗，以 42%最大标准摄取值（SUV）作为原发肿瘤的阈值。根据 PET 数据，将患者按 1:1.5 的比例分为训练和验证队列。获得异质性和不规则性指数。在受试者工作特征曲线和单因素 Cox 模型中，确定对无进展生存期（PFS）有显著影响的 PET 参数，并将其纳入递归分区分析（RPA）中构建预后模型。使用多因素 Cox 模型在验证队列中进一步测试 RPA 预后模型。
分别有 58 例和 89 例患者纳入训练组和验证组。异质性参数、SUV 熵（来自直方图分析）和不规则性指数、以及各向异性与 PFS 显著相关。RPA 模型显示，SUV 熵和各向异性均较高的患者 PFS 最差。在验证组中得到了验证。模型对 PFS 的总一致性指数为 0.75，高于临床分期、体能状态、SUV 和 PET 的代谢肿瘤体积。
PET 预后模型为高危 OPSCC 患者的 PFS 提供了有用的预测。
