Fatima Nosheen, Zaman Areeba, Zaman Unaiza, Zaman Sidra, Tahseen Rabia, Zaman Maseeh Uz
Section of NM and PET/CT, Department of Radiology, The Aga Khan University Hospital (AKUH), Karachi, Pakistan.
Department of Medicine, Dow Medical College, Dow University Health Sciences (DUHS), Karachi, Pakistan.
World J Nucl Med. 2022 Feb 24;21(1):9-17. doi: 10.1055/s-0042-1744197. eCollection 2022 Mar.
The purpose fo this prospective study was to find the impact of primary tumor size (Ts), standardized uptake values (SUVmax) of primary tumor, and the most avid neck node on disease recurrence in patients with head and neck oropharyngeal squamous cell carcinoma (HNOP-SCC). We included patients with HNOP-SCC (without distant metastasis-M0 disease) who had pre- and post-treatment F-18 fluorodeoxyglucose positron emission tomography/computed tomography ( FDG PET/CT) using strict standardized imaging protocol from 2017 to 2019. Based on follow-up ( FDG PET/CT) findings, patients were categorized as disease free (no or minimal FDG uptake ≤ background over surgical bed and no distant metastasis) and disease recurrence ( FDG uptake > background over surgical bed with or without nodal and/or distant metastasis). Ts and SUVmax of primary tumor and the most avid neck node were compared and impact of these was studied upon disease recurrence. Total 112 patients were included. No significant difference was seen in mean age (overall: 60 ± 14 years), gender distribution (overall M:F: 69:31%), body mass index (overall: 25.20 ± 5.82), and history of diabetes (overall: 19%) between disease-free and disease recurrence groups. Similarly, no significant difference was observed for fasting blood sugar (overall: 110 ± 28 mg%), FDG dose (overall: 169 ± 37 MBq), and uptake period (overall: 70 ± 12 minutes) between two groups ensuring strict adherence to standardized imaging protocol. Significant difference ( < 0.05) was observed between disease-free and disease recurrence for Ts (25 ± 10 vs. 33 ± 14 mm), SUVmax of primary tumor (6.2 ± 6.8 vs. 9.3 ± 7.2) and the most avid neck node (2.1 ± 3.3 vs. 4.7 ± 5.9) and median follow-up (13 ± 12 vs. 08 ± 13 months), respectively. Using receiver operating characteristic analysis, Ts greater than 29 mm, baseline tumor SUVmax greater than 4.6, and nodal SUVmax greater than 6.2 were found independent predictors for disease recurrence. Nodal SUVmax greater than 6.2 was found an independent predictor of shortest disease-free survival (DFS) than Ts and tumor SUVmax. We conclude that in HNOP-SCC, primary Ts (> 29 mm), SUVmax of primary tumor (> 4.6), and the most avid neck node (> 6.2) in baseline FDG PET/CT using standardized imaging protocol are the independent predictors of disease recurrence. Furthermore, SUVmax greater than 6.2 of the most avid node predicts the shortest DFS than primary Ts and SUVmax of primary tumor.
这项前瞻性研究的目的是探讨原发性肿瘤大小（Ts）、原发性肿瘤的标准化摄取值（SUVmax）以及最活跃颈部淋巴结对头颈部口咽鳞状细胞癌（HNOP-SCC）患者疾病复发的影响。
我们纳入了2017年至2019年期间接受过治疗前和治疗后F-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）且采用严格标准化成像方案的HNOP-SCC患者（无远处转移-M0期疾病）。根据随访（FDG PET/CT）结果，将患者分为无疾病组（手术床无或仅有微量FDG摄取≤背景且无远处转移）和疾病复发组（手术床FDG摄取>背景，伴或不伴有淋巴结和/或远处转移）。比较原发性肿瘤和最活跃颈部淋巴结的Ts及SUVmax，并研究其对疾病复发的影响。
共纳入112例患者。无疾病组和疾病复发组在平均年龄（总体：60±14岁）、性别分布（总体男性：女性为69：31%）、体重指数（总体：25.20±5.82）和糖尿病病史（总体：19%）方面无显著差异。同样，两组在空腹血糖（总体：110±28mg%）、FDG剂量（总体：169±37MBq）和摄取时间（总体：70±12分钟）方面也无显著差异，确保严格遵守标准化成像方案。无疾病组和疾病复发组在Ts（25±10 vs. 33±14mm）、原发性肿瘤的SUVmax（6.2±6.8 vs. 9.3±7.2）和最活跃颈部淋巴结（2.1±3.3 vs. 4.7±5.9）以及中位随访时间（13±12 vs. 08±13个月）方面分别存在显著差异（P<0.05）。通过受试者工作特征分析，发现Ts大于29mm、基线肿瘤SUVmax大于4.6以及淋巴结SUVmax大于6.2是疾病复发的独立预测因素。发现淋巴结SUVmax大于6.2是比Ts和肿瘤SUVmax更短无疾病生存期（DFS）的独立预测因素。
我们得出结论，在HNOP-SCC中，采用标准化成像方案的基线FDG PET/CT中，原发性Ts（>29mm）、原发性肿瘤的SUVmax（>4.6）以及最活跃颈部淋巴结（>6.2）是疾病复发的独立预测因素。此外，最活跃淋巴结的SUVmax大于6.2比原发性Ts和原发性肿瘤的SUVmax预测的DFS更短。
