From the Departments of Nuclear Medicine, and.
Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Clin Nucl Med. 2018 Jul;43(7):e220-e225. doi: 10.1097/RLU.0000000000002145.
Distant failure is a major concern in patients with nasopharyngeal carcinoma. We evaluated whether the metabolic features on F-FDG PET/CT can predict distant metastasis-free survival (DMFS) in patients with locally advanced nasopharyngeal carcinoma.
We retrospectively reviewed 51 patients stage III, IVA, and IVB nasopharyngeal carcinoma who underwent F-FDG PET/CT at staging. The SUVmax for the primary site and the lymph nodes with the highest uptake as well as at the farthest station were divided by the SUVmean of the background liver (TLR, NLR-H, and NLR-F, respectively). The prognostic value of clinicopathologic factors and SUV parameters for predicting DMFS were assessed using a Cox proportional hazards model. Differences in DMFS were examined by the Kaplan-Meier method.
In the median follow-up period of 50.4 ± 39.3 months (median ± interquartile range; range, 3.8-130.9), distant metastasis developed in 11 patients (21.6%). In univariate analyses, N stage (N3b) (P = 0.003) and NLR-H >5.70 (P = 0.02) were significant prognostic factors for DMFS, and remained significant in multivariate analysis, whereas TLR (P = 0.18) and NLR-F (P = 0.76) did not. The Kaplan-Meier curves showed significantly poorer DMFS in patients with NLR-H >5.70 than in those with lower NLR-H (≤5.70) (1-year DMFS rate, 84.2% vs 93.5%; P = 0.01).
In addition to anatomical N stage, higher NLR-H on pretreatment F-FDG PET/CT is an independent prognostic factor for worse DMFS in patients with locally advanced nasopharyngeal carcinoma.
远处失败是鼻咽癌患者的主要关注点。我们评估了 F-FDG PET/CT 的代谢特征是否可以预测局部晚期鼻咽癌患者的无远处转移生存（DMFS）。
我们回顾性分析了 51 例分期时接受 F-FDG PET/CT 检查的 III、IVA 和 IVB 期鼻咽癌患者。原发灶和摄取最高的淋巴结以及最远部位的 SUVmax 分别除以背景肝脏的 SUVmean（分别为 TLR、NLR-H 和 NLR-F）。使用 Cox 比例风险模型评估临床病理因素和 SUV 参数对预测 DMFS 的预后价值。通过 Kaplan-Meier 方法检查 DMFS 的差异。
在中位数为 50.4±39.3 个月（中位数±四分位距；范围，3.8-130.9）的中位随访期间，11 例（21.6%）患者发生远处转移。在单因素分析中，N 分期（N3b）（P=0.003）和 NLR-H＞5.70（P=0.02）是 DMFS 的显著预后因素，多因素分析中仍然显著，而 TLR（P=0.18）和 NLR-F（P=0.76）则不然。Kaplan-Meier 曲线显示 NLR-H＞5.70 的患者 DMFS 明显较差，低于 NLR-H 较低的患者（≤5.70）（1 年 DMFS 率，84.2%比 93.5%；P=0.01）。
除了解剖 N 分期外，治疗前 F-FDG PET/CT 上的 NLR-H 较高是局部晚期鼻咽癌患者 DMFS 较差的独立预后因素。
