Bae Mi Rye, Roh Jong-Lyel, Kim Jae Seung, Choi Seung-Ho, Nam Soon Yuhl, Kim Sang Yoon
Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Songnam, Gyeonggi-do, 13496, Republic of Korea.
J Cancer Res Clin Oncol. 2020 Dec;146(12):3341-3348. doi: 10.1007/s00432-020-03313-8. Epub 2020 Jul 8.
Oral cavity squamous cell carcinoma (OCC) can spread to the neck without apparent lymphadenopathy. Pretreatment detection or prediction of occult metastasis might contribute to proper management of clinically node-negative (cN0) OCC. We examined the role of tumour quantitative 18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) measurements for predicting OCC occult metastasis and survival.
This study included 130 cN0 OCC patients who underwent F-FDG PET/CT scanning and subsequent curative surgery and neck dissection. Maximum, peak, and mean standardized uptake value (SUV, SUV, and SUV), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were measured on pretreatment F-FDG PET/CT. Binary logistic regression was used to identify factors predicting occult cervical metastasis. Univariate and multivariate Cox proportional hazard regression were used to find factors associated with overall survival (OS).
Pathological cervical metastasis (pN +) was found in 29 (22.3%) patients. Age, tumour differentiation, lymphovascular invasion, and T classification were significantly associated with pN + (all P < 0.05). After adjustment for these factors, MTV and TLG independently predicted pN + (P < 0.05). Invasion depth, lymphovascular invasion, T and N classifications, and overall TNM stage were significantly associated with OS. After adjustment for these factors, SUV and TLG independently predicted OS (all P < 0.05). Patients with TLG > 9.3 g had a 5.7-fold increased risk of overall mortality.
Tumour F-FDG PET/CT parameters might predict occult metastasis and survival in cN0 OCC patients.
口腔鳞状细胞癌（OCC）可在无明显淋巴结病的情况下扩散至颈部。术前检测或预测隐匿性转移可能有助于对临床淋巴结阴性（cN0）的OCC进行适当管理。我们研究了肿瘤定量18氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）测量在预测OCC隐匿性转移和生存方面的作用。
本研究纳入了130例cN0的OCC患者，这些患者接受了F-FDG PET/CT扫描，随后进行了根治性手术和颈部淋巴结清扫。在术前F-FDG PET/CT上测量最大、峰值和平均标准化摄取值（SUVmax、SUVpeak和SUVmean）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。采用二元逻辑回归来确定预测隐匿性颈部转移的因素。采用单因素和多因素Cox比例风险回归来寻找与总生存期（OS）相关的因素。
29例（22.3%）患者发现病理性颈部转移（pN+）。年龄、肿瘤分化、脉管侵犯和T分期与pN+显著相关（均P<0.05）。在对这些因素进行调整后，MTV和TLG独立预测pN+（P<0.05）。浸润深度、脉管侵犯、T和N分期以及总的TNM分期与OS显著相关。在对这些因素进行调整后，SUVpeak和TLG独立预测OS（均P<0.05）。TLG>9.3 g的患者总死亡风险增加5.7倍。
肿瘤F-FDG PET/CT参数可能预测cN0的OCC患者的隐匿性转移和生存情况。
