对接受手术切除的口腔鳞状细胞癌患者进行预后分层时，联合分析FDG-PET最大标准化摄取值、基因标志物和临床病理危险因素。
A combined analysis of maximum standardized uptake value on FDG-PET, genetic markers, and clinicopathological risk factors in the prognostic stratification of patients with resected oral cavity squamous cell carcinoma.
作者信息
Liao Chun-Ta, Hsieh Chia-Hsun, Fan Wen-Lang, Ng Shu-Hang, Cheng Nai-Ming, Lee Li-Yu, Hsueh Chuen, Lin Chien-Yu, Fan Kang-Hsing, Wang Hung-Ming, Lin Chih-Hung, Tsao Chung-Kan, Kang Chung-Jan, Fang Tuan-Jen, Huang Shiang-Fu, Chang Kai-Ping, Lee Li-Ang, Fang Ku-Hao, Wang Yu-Chien, Yang Lan-Yan, Yen Tzu-Chen
机构信息
Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China.
Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China.
出版信息
Eur J Nucl Med Mol Imaging. 2020 Jan;47(1):84-93. doi: 10.1007/s00259-019-04453-x. Epub 2019 Aug 6.
OBJECTIVE
Clinical outcomes of patients with resected oral cavity squamous cell carcinoma (OCSCC) chiefly depend on the presence of specific clinicopathological risk factors (RFs). Here, we performed a combined analysis of FDG-PET, genetic markers, and clinicopathological RFs in an effort to improve prognostic stratification.
METHODS
We retrospectively reviewed the clinical records of 2036 consecutive patients with first primary OCSCC who underwent surgery between 1996 and 2016. Of them, 345 underwent ultra-deep targeted sequencing (UDTS, between 1996 and 2011) and 168 whole exome sequencing (WES, between 2007 and 2016). Preoperative FDG-PET imaging was performed in 1135 patients from 2001 to 2016. Complete data on FDG-PET, genetic markers, and clinicopathological RFs were available for 327 patients.
RESULTS
Using log-ranked tests based on 5-year disease-free survival (DFS), the optimal cutoff points for maximum standardized uptake values (SUV-max) of the primary tumor and neck metastatic nodes were 22.8 and 9.7, respectively. The 5-year DFS rates were as follows: SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7 (n = 77) versus SUVtumor-max < 22.8 and SUVnodal-max < 9.7 (n = 250), 32%/62%, P < 0.001; positive UDTS or WES gene panel (n = 64) versus negative (n = 263), 25%/62%, P < 0.001; pN3b (n = 165) versus pN1-2 (n = 162), 42%/68%, P < 0.001. On multivariate analyses, SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7, a positive UDTS/WES gene panel, and pN3b disease were identified as independent prognosticators for 5-year outcomes. Based on these variables, we devised a scoring system that identified four distinct prognostic groups. The 5-year rates for patients with a score from 0 to 3 were as follows: loco-regional control, 80%/67%/47%/24% (P < 0.001); distant metastases, 13%/23%/55%/92% (P < 0.001); DFS, 74%/58%/28%/7% (P < 0.001); and disease-specific survival, 80%/64%/35%/7% (P < 0.001) respectively.
CONCLUSIONS
The combined assessment of tumor and nodal SUV-max, genetic markers, and pathological node status may refine the prognostic stratification of OCSCC patients.
目的
口腔鳞状细胞癌（OCSCC）切除术后患者的临床结局主要取决于特定的临床病理危险因素（RFs）。在此，我们对FDG-PET、基因标志物和临床病理RFs进行了联合分析，以改善预后分层。
方法
我们回顾性分析了1996年至2016年间连续接受手术的2036例原发性OCSCC患者的临床记录。其中，345例接受了超深度靶向测序（UDTS，1996年至2011年），168例接受了全外显子测序（WES，2007年至2016年）。2001年至2016年期间，1135例患者进行了术前FDG-PET成像。327例患者可获得关于FDG-PET、基因标志物和临床病理RFs的完整数据。
结果
基于5年无病生存期（DFS）的对数秩检验，原发肿瘤和颈部转移淋巴结的最大标准化摄取值（SUV-max）的最佳截断点分别为22.8和9.7。5年DFS率如下：SUV肿瘤-max≥22.8或SUV淋巴结-max≥9.7（n = 77）与SUV肿瘤-max<22.8且SUV淋巴结-max<9.7（n = 250），32%/62%，P<0.001；UDTS或WES基因检测阳性（n = 64）与阴性（n = 263），25%/62%，P<0.001；pN3b（n = 165）与pN1-2（n = 162），42%/68%，P<0.001。多因素分析显示，SUV肿瘤-max≥22.8或SUV淋巴结-max≥9.7、UDTS/WES基因检测阳性和pN3b疾病被确定为5年结局的独立预后因素。基于这些变量，我们设计了一个评分系统，确定了四个不同的预后组。评分为0至3分的患者5年率如下：局部区域控制率，80%/67%/47%/24%（P<0.001）；远处转移率，13%/23%/55%/92%（P<0.001）；DFS率，74%/58%/28%/7%（P<0.001）；疾病特异性生存率，80%/64%/35%/7%（P<0.001）。
结论
肿瘤和淋巴结SUV-max、基因标志物以及病理淋巴结状态的联合评估可能会优化OCSCC患者的预后分层。
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