From the Department of Radiation Oncology.
Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Clin Nucl Med. 2019 May;44(5):e323-e328. doi: 10.1097/RLU.0000000000002531.
Oropharynx cancer (OPC) is heterogeneous; human papillomavirus (HPV)-positive and HPV tumors represent 2 disease entities with a different prognosis. Earlier studies investigating the prognostic value of pretreatment F-FDG PET in OPC are small or included patients with unknown HPV status. This study assessed the prognostic value of PET variables, in a large cohort with balanced HPV status.
Retrospectively, primary tumor SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were extracted from baseline FDG PET/CT of patients with OPC treated with (chemo)radiation. The Pearson correlation between the PET variables was calculated. With linear regression, the correlation between the PET variables and HPV status, age, smoking status, T stage, N stage, and American Joint Committee on Cancer stage was calculated. Univariable and multivariable Cox models analyzed local control, overall survival, and disease-free survival (DFS).
Of 201 patients, 109 were HPV. Metabolic tumor volume and TLG correlated (r = 0.96), as did SUVpeak and SUVmax (r = 0.97). The PET variables correlated strongest with HPV status and T stage. These two accounted for 40% of the variance of MTV and 33% of TLG. Human papillomavirus-negative tumors had a significantly higher SUVmax, SUVpeak, MTV, and TLG. In univariable analysis, all PET variables were significantly associated with local control, overall survival, and DFS. In multivariable analysis, TLG was significantly associated to DFS in patients with HPV OPC (hazard ratio, 1.005; 95% confidence interval, 1.001-1.010; P = 0.03). However, we did not observe this in HPV patients.
Increased baseline TLG is associated with worse DFS in HPV OPC and might be used as biomarker for risk stratification in these patients. Interestingly, we could not identify this association in HPV patients.
口咽癌（OPC）具有异质性；人乳头瘤病毒（HPV）阳性和 HPV 肿瘤代表 2 种具有不同预后的疾病实体。早期研究调查了 OPC 中预处理 F-FDG PET 的预后价值，但这些研究规模较小或纳入了 HPV 状态未知的患者。本研究在 HPV 状态平衡的大队列中评估了 PET 变量的预后价值。
回顾性地从接受（放）化疗的 OPC 患者的基线 FDG PET/CT 中提取原发肿瘤 SUVmax、SUVpeak、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）。计算 PET 变量之间的 Pearson 相关性。通过线性回归，计算 PET 变量与 HPV 状态、年龄、吸烟状态、T 分期、N 分期和美国癌症联合委员会（AJCC）分期之间的相关性。单变量和多变量 Cox 模型分析局部控制、总生存和无病生存（DFS）。
在 201 名患者中，有 109 名患者 HPV 阳性。MTV 和 TLG 之间存在相关性（r = 0.96），SUVpeak 和 SUVmax 之间也存在相关性（r = 0.97）。PET 变量与 HPV 状态和 T 分期相关性最强。这两个因素占 MTV 的 40%和 TLG 的 33%。HPV 阴性肿瘤的 SUVmax、SUVpeak、MTV 和 TLG 明显更高。在单变量分析中，所有 PET 变量均与局部控制、总生存和 DFS 显著相关。在多变量分析中，TLG 与 HPV OPC 患者的 DFS 显著相关（危险比，1.005；95%置信区间，1.001-1.010；P = 0.03）。然而，我们在 HPV 患者中没有观察到这种情况。
基线 TLG 升高与 HPV OPC 的DFS 较差相关，可能作为这些患者风险分层的生物标志物。有趣的是，我们无法在 HPV 患者中识别出这种关联。
