Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
University of Zurich, Zurich, Switzerland.
Sci Rep. 2020 Oct 7;10(1):16689. doi: 10.1038/s41598-020-73914-3.
18-flurodesoxyglucose position emission tomography (FDG-PET) with computed tomography (CT) or magnetic resonance imaging (MRI) is a broadly accepted tool for pretherapeutic staging and post-therapeutic assessment of response. The prognostic value of sequential post-therapeutic FDG-PETs and the impact of change in metabolic activity has been scarcely reported so far. We hypothesized that an increase in metabolic activity (as measured by maximum standardized uptake value, SUVmax) would be predictive for recurrence. We retrospectively assessed all oral, oropharyngeal, laryngeal, and hypopharyngeal squamous cell carcinoma patients treated at the Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich between April 1st, 2010 and September 30th, 2018 (N = 337). After a negative post-treatment FDG-PET at 3 months, we measured the SUVmax of the local tumor area and the regional lymph nodes on follow-up FDG-PET at 9 months. We then correlated SUVmax difference between 9 and 3 months with tumor recurrence using Kaplan Meier analysis. During follow-up, 68 patients (20.2%) had local recurrence and 53 had regional recurrence (15.7%) at a median time of 9.0 (IQR 4.25-14) and 7.0 (IQR 5.25-23) months, respectively. An increase in local and/or regional SUVmax from the 3 months to the 9 months post-therapeutic FDG-PET resulted in a poorer recurrence-free survival (Log rank, P = 0.001, for both). An increase in local SUVmax between 3 and 9 months was associated with a hazard ratio of 4.17 for recurrence (95%CI 1.89-9.2, P = 0.0003). In conclusion, an increase in metabolic activity/SUVmax between two post-therapeutic FDG-PETs requires a histological examination as it is associated with tumor recurrence.
18-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）联合计算机断层扫描（CT）或磁共振成像（MRI）是一种广泛接受的用于治疗前分期和治疗后反应评估的工具。目前，关于治疗后连续 FDG-PET 代谢活性的预后价值及其变化的影响鲜有报道。我们假设代谢活性的增加（通过最大标准化摄取值 SUVmax 来衡量）将具有预测复发的能力。我们回顾性评估了 2010 年 4 月 1 日至 2018 年 9 月 30 日期间在苏黎世大学医院耳鼻喉头颈外科接受治疗的所有口腔、口咽、喉和下咽鳞状细胞癌患者（N=337）。在治疗后 3 个月 FDG-PET 阴性后，我们在 9 个月的随访 FDG-PET 上测量局部肿瘤区域和区域淋巴结的 SUVmax。然后，我们使用 Kaplan-Meier 分析将 9 个月和 3 个月之间的 SUVmax 差值与肿瘤复发相关联。在随访期间，68 名患者（20.2%）在中位时间 9.0（IQR 4.25-14）出现局部复发，53 名患者（15.7%）出现区域复发，7.0（IQR 5.25-23）个月。治疗后 FDG-PET 后 3 个月至 9 个月时，局部和/或区域 SUVmax 的增加导致无复发生存率较差（对数秩检验，P=0.001，均如此）。3 个月至 9 个月之间局部 SUVmax 的增加与复发的风险比相关，HR 为 4.17（95%CI 1.89-9.2，P=0.0003）。总之，两次治疗后 FDG-PET 之间代谢活性/SUVmax 的增加需要进行组织学检查，因为它与肿瘤复发相关。
