Radiotherapy Department, Cancer Institute Eugène Marquis, 35000, Rennes, France.
INSERM, U1099, 35000, Rennes, France.
Eur J Nucl Med Mol Imaging. 2019 Mar;46(3):638-649. doi: 10.1007/s00259-018-4134-9. Epub 2018 Aug 21.
The aims of this multicentre retrospective study of locally advanced head and neck cancer (LAHNC) treated with definitive radiotherapy were to (1) identify positron emission tomography (PET)-F-fluorodeoxyglucose (F-FDG) parameters correlated with overall survival (OS) in a training cohort, (2) compute a prognostic model, and (3) externally validate this model in an independent cohort.
A total of 237 consecutive LAHNC patients divided into training (n = 127) and validation cohorts (n = 110) were retrospectively analysed. The following PET parameters were analysed: SUV, metabolic tumour volume (MTV), total lesion glycolysis (TLG), and SUV for the primary tumour and lymph nodes using a relative SUV threshold or an absolute SUV threshold. Cox analyses were performed on OS in the training cohort. The c-index was used to identify the highly prognostic parameters. A prognostic model was subsequently identified, and a nomogram was generated. The model was externally tested in the validation cohort.
In univariate analysis, the significant PET parameters for the primary tumour included MTV (relative thresholds from 6 to 83% and absolute thresholds from 1.5 to 6.5) and TLG (relative thresholds from 1 to 82% and absolute thresholds from 0.5 to 4.5). For the lymph nodes, the significant parameters included MTV and TLG regardless of the threshold value. In multivariate analysis, tumour site, p16 status, MTV35% of the primary tumour, and MTV44% of the lymph nodes were independent predictors of OS. Based on these four parameters, a prognostic model was identified with a c-index of 0.72. The corresponding nomogram was generated. This prognostic model was externally validated, achieving a c-index of 0.66.
A prognostic model of OS based on primary tumour and lymph node MTV, tumour site, and p16 status was proposed and validated. The corresponding nomogram may be used to tailor individualized treatment.
本多中心回顾性研究旨在探讨局部晚期头颈部癌（LAHNC）患者接受根治性放疗的结果。（1）在训练队列中确定与总生存期（OS）相关的正电子发射断层扫描（PET）-氟代脱氧葡萄糖（F-FDG）参数；（2）构建一个预测模型；（3）并在独立队列中验证该模型。
共回顾性分析了 237 例连续的 LAHNC 患者，分为训练队列（n=127）和验证队列（n=110）。分析了以下 PET 参数：SUV、肿瘤代谢体积（MTV）、总病灶糖酵解（TLG）以及使用相对 SUV 阈值或绝对 SUV 阈值的原发肿瘤和淋巴结的 SUV。在训练队列中进行了 COX 分析。C 指数用于识别高预后参数。随后确定了一个预测模型，并生成了一个列线图。在验证队列中对该模型进行了外部检验。
在单因素分析中，原发肿瘤的显著 PET 参数包括 MTV（相对阈值范围为 6%至 83%，绝对阈值范围为 1.5 至 6.5）和 TLG（相对阈值范围为 1%至 82%，绝对阈值范围为 0.5 至 4.5）。对于淋巴结，无论阈值如何，MTV 和 TLG 都是显著参数。在多因素分析中，肿瘤部位、p16 状态、原发肿瘤 MTV35%和淋巴结 MTV44%是 OS 的独立预测因子。基于这四个参数，建立了一个预测 OS 的模型，C 指数为 0.72。相应的列线图生成。该预测模型在外部验证中，C 指数为 0.66。
提出并验证了一个基于原发肿瘤和淋巴结 MTV、肿瘤部位和 p16 状态的 OS 预测模型。相应的列线图可用于制定个体化治疗方案。
