Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
Radiat Oncol. 2021 Nov 27;16(1):229. doi: 10.1186/s13014-021-01954-8.
To identify the subset of patients with de novo nasopharyngeal carcinoma (NPC) for whom [F] fluorodeoxyglucose positron emission tomography and computed tomography (F-FDG PET/CT) should be recommended, and to determine whether PET/CT is a cost-effective decision for precise M staging in endemic areas.
Retrospective analysis of data of 4469 patients diagnosed with de novo NPC between January 2014 and December 2019. The detection rate of distant metastasis was compared between different groups. Univariate and multiple logistic regression analysis was applied to identify the risk factors for distant metastasis. The cost-effectiveness of the diagnostic strategies was assessed.
The detection rate of distant metastasis in the whole cohort was 5.46%. In multivariate analysis, male sex, T3-4 stage, N2-3 stage, and high plasma Epstein-Barr virus (EBV) DNA (≥ 14,650 copies/mL) were risk factors for distant metastases. NPC patients with T3-4 stage combined with N2-3 stage, high EBV DNA combined with male sex, or N2-3 stage combined with high EBV DNA were defined as recommended group with relatively higher tendency for metastasis. Distant metastasis incidence in recommended group and unrecommended group were 10.25% and 1.75%, respectively (P < 0.001). In the recommended group, PET/CT significantly improved the detection rate of distant metastasis (13.25% vs 9.02%, P = 0.005). Cost-effectiveness analysis revealed that additional cost for every one percent increase in distant metastasis detection rate was $22,785.58 in the recommended group (< Willingness-to-pay (WTP) threshold of $32,700.00) and $310,912.90 in the unrecommended group.
In patients with de novo NPC, the tendency for metastasis can be predicted based on clinical parameters. F-FDG PET/CT should be selectively recommended for the subset of patients with a relatively higher tendency for metastasis.
为了确定哪些初诊鼻咽癌（NPC）患者需要推荐使用[F]氟脱氧葡萄糖正电子发射断层扫描和计算机断层扫描（F-FDG PET/CT），并确定 PET/CT 是否是地方性高发地区精确 M 分期的一种具有成本效益的决策。
回顾性分析 2014 年 1 月至 2019 年 12 月期间诊断为初诊 NPC 的 4469 例患者的数据。比较不同组别的远处转移检出率。应用单因素和多因素逻辑回归分析确定远处转移的危险因素。评估诊断策略的成本效益。
全队列远处转移的检出率为 5.46%。多因素分析显示，男性、T3-4 期、N2-3 期和高血浆 Epstein-Barr 病毒（EBV）DNA（≥14650 拷贝/ml）是远处转移的危险因素。将 T3-4 期合并 N2-3 期、高 EBV DNA 合并男性、或 N2-3 期合并高 EBV DNA 的 NPC 患者定义为具有较高转移倾向的推荐组。推荐组和非推荐组的远处转移发生率分别为 10.25%和 1.75%（P<0.001）。在推荐组中，PET/CT 显著提高了远处转移的检出率（13.25%比 9.02%，P=0.005）。成本效益分析显示，推荐组中每增加一个百分点的远处转移检出率，额外成本为 22785.58 美元（低于 32700.00 美元的意愿支付（WTP）阈值），而非推荐组中额外成本为 310912.90 美元。
在初诊 NPC 患者中，可以根据临床参数预测转移倾向。对于转移倾向较高的患者，应选择性推荐使用 F-FDG PET/CT。
