头颈部癌术后放疗后预测治疗结果的放疗后 PET/CT。
Post-radiotherapy PET/CT for predicting treatment outcomes in head and neck cancer after postoperative radiotherapy.
机构信息
Department of Radiation Oncology, West China Hospital of Sichuan University, Chengdu, China.
Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
出版信息
Eur J Nucl Med Mol Imaging. 2019 Apr;46(4):794-800. doi: 10.1007/s00259-019-4272-8. Epub 2019 Jan 24.
PURPOSE
The purpose of this study was to retrospectively review the role of post-treatment (post-tx) FDG-PET/CT scans in patients receiving postoperative intensity-modulated radiotherapy (IMRT) for head and neck squamous cell carcinomas (HNSCC).
MATERIALS AND METHODS
Eighty-two patients with HNSCC treated with surgery and postoperative IMRT with or without chemotherapy from October 15, 2008 to December 31, 2014 that had post-tx PET/CT within 6 months of completing IMRT were included. PET/CT was considered positive based on multi-disciplinary review integrating clinical information. Survival analysis was performed using the Kaplan-Meier method. Categorical and continuous predictors of positive post-tx PET/CT were evaluated using Fisher's exact test and logistic regression, respectively. Predictors for survival outcomes were evaluated with log-rank testing. A p ≤ 0.05 was considered statistically significant.
RESULTS
Median follow-up was 3.88 years. For all patients, 3-year overall survival (OS) and recurrence-free survival (RFS) were 71.8% and 61.3%, respectively. Patients with positive post-tx PET/CT had worse OS compared to those with negative post-tx PET/CT (log rank p < 0.001). For patients with positive post-tx PET/CT, 3-year OS was 11.2% compared to 89.9% for patients with negative post-tx PET/CT. The positive predictive value (PPV) of PET/CT was 100% for local recurrence (LR), regional recurrence (RR) and distant metastasis (DM). The negative predictive values (NPV) for LR, RR and DM were 89.0%, 89.2%, and 85.9%, respectively. Perineural invasion (p = 0.009), p16 status (p = 0.009), non-oropharyngeal primary site (p = 0.002), and the use of chemotherapy (p = 0.01) were independent predictors of positive PET/CT.
CONCLUSIONS
Post-tx PET/CT after postoperative radiation is prognostic for survival outcomes. The PPV of post-tx PET for recurrence was excellent, allowing for early detection of recurrent disease. Post-tx PET/CT should be considered after postoperative radiation.
目的
本研究旨在回顾性分析接受术后调强放疗（IMRT）治疗的头颈部鳞状细胞癌（HNSCC）患者治疗后（post-tx）FDG-PET/CT 扫描的作用。
材料与方法
2008 年 10 月 15 日至 2014 年 12 月 31 日，82 例接受手术和术后 IMRT 治疗且 IMRT 后 6 个月内行 post-tx PET/CT 的 HNSCC 患者纳入本研究。PET/CT 结果阳性基于多学科综合评估整合临床信息得出。采用 Kaplan-Meier 法进行生存分析。采用 Fisher 确切检验和 logistic 回归分别评估阳性 post-tx PET/CT 的分类和连续预测因子。采用对数秩检验评估生存结果的预测因子。p≤0.05 为统计学显著。
结果
中位随访时间为 3.88 年。所有患者的 3 年总生存率（OS）和无复发生存率（RFS）分别为 71.8%和 61.3%。post-tx PET/CT 阳性患者的 OS 明显差于 post-tx PET/CT 阴性患者（log rank p<0.001）。post-tx PET/CT 阳性患者的 3 年 OS 为 11.2%，而 post-tx PET/CT 阴性患者的 3 年 OS 为 89.9%。PET/CT 对局部复发（LR）、区域复发（RR）和远处转移（DM）的阳性预测值（PPV）均为 100%。LR、RR 和 DM 的阴性预测值（NPV）分别为 89.0%、89.2%和 85.9%。神经周围侵犯（p=0.009）、p16 状态（p=0.009）、非口咽原发灶（p=0.002）和化疗的使用（p=0.01）是 post-tx PET/CT 阳性的独立预测因子。
结论
术后放疗后 post-tx PET/CT 对生存结果有预后作用。post-tx PET 对复发的 PPV 非常高，可早期发现复发疾病。术后放疗后应考虑行 post-tx PET/CT。
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