Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy.
Radiation Oncology, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy.
Eur J Nucl Med Mol Imaging. 2018 Nov;45(12):2122-2138. doi: 10.1007/s00259-018-4065-5. Epub 2018 Jun 9.
Evidence is conflicting on the prognostic value of F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of our study was to determine the impact of semiquantitative and qualitative metabolic parameters on the outcome in patients managed with standard treatment for locally advanced disease.
A systematic review of the literature was conducted. A meta-analysis was performed of studies providing estimates of relative risk (RR) for the association between semiquantitative metabolic parameters and efficacy outcome measures.
The analysis included 25 studies, for a total of 2,223 subjects. The most frequent primary tumour site was the oropharynx (1,150/2,223 patients, 51.7%). According to the available data, the majority of patients had stage III/IV disease (1,709/1,799, 94.9%; no information available in four studies) and were treated with standard concurrent chemoradiotherapy (1,562/2,009 patients, 77.7%; only one study without available information). A total of 11, 8 and 4 independent studies provided RR estimates for the association between baseline FDG PET metrics and overall survival (OS), progression-free survival (PFS) and locoregional control (LRC), respectively. High pretreatment metabolic tumour volume (MTV) was significantly associated with a worse OS (summary RR 1.86, 95% CI 1.08-3.21), PFS (summary RR 1.81, 95% CI 1.14-2.89) and LRC (summary RR 3.49, 95% CI 1.65-7.35). Given the large heterogeneity (I > 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUV and any of the outcome measures.
FDG PET has prognostic relevance in the context of locally advanced head and neck squamous cell carcinoma. Pretreatment MTV is the only metabolic variable with a significant impact on patient outcome. Because of the heterogeneity and the lack of standardized methodology, no definitive conclusions on optimal cut-off values can be drawn.
氟-18 氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）在头颈部鳞状细胞癌中的预后价值存在争议。我们的研究目的是确定在接受标准局部晚期疾病治疗的患者中，半定量和定性代谢参数对结局的影响。
对文献进行系统回顾。对提供半定量代谢参数与疗效指标之间关联的相对风险（RR）估计值的研究进行荟萃分析。
分析纳入了 25 项研究，共 2223 例患者。最常见的原发肿瘤部位是口咽（1150/2223 例，51.7%）。根据现有数据，大多数患者患有 III/IV 期疾病（1709/1799 例，94.9%；4 项研究中无信息），并接受标准同期放化疗（1562/2009 例，77.7%；仅有 1 项研究无信息）。共有 11、8 和 4 项独立研究分别提供了基线 FDG PET 指标与总生存期（OS）、无进展生存期（PFS）和局部区域控制（LRC）之间关联的 RR 估计值。高预处理代谢肿瘤体积（MTV）与较差的 OS（汇总 RR 1.86，95%CI 1.08-3.21）、PFS（汇总 RR 1.81，95%CI 1.14-2.89）和 LRC（汇总 RR 3.49，95%CI 1.65-7.35）显著相关。由于影响汇总指标的异质性较大（I>50%），无法定义不利预后的累积阈值。SUV 与任何结局指标均无统计学显著相关性。
FDG PET 在局部晚期头颈部鳞状细胞癌中具有预后相关性。预处理 MTV 是唯一对患者结局有显著影响的代谢变量。由于异质性和缺乏标准化方法，无法得出关于最佳截断值的明确结论。
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