F18-FDG PET/CT成像可早期预测局部晚期头颈癌诱导化疗免疫治疗后的病理完全缓解：CheckRad-CD8试验的单中心初步分析
F18-FDG PET/CT imaging early predicts pathologic complete response to induction chemoimmunotherapy of locally advanced head and neck cancer: preliminary single-center analysis of the checkrad-cd8 trial.
作者信息
Beck M, Hartwich J, Eckstein M, Schmidt D, Gostian A O, Müller S, Rutzner S, Gaipl U S, von der Grün J, Illmer T, Hautmann M G, Klautke G, Döscher J, Brunner T, Tamaskovics B, Hartmann A, Iro H, Kuwert T, Fietkau R, Hecht M, Semrau S
机构信息
Clinic of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Bayern, Germany.
Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany.
出版信息
Ann Nucl Med. 2022 Jul;36(7):623-633. doi: 10.1007/s12149-022-01744-6. Epub 2022 May 10.
AIM
In the CheckRad-CD8 trial patients with locally advanced head and neck squamous cell cancer are treated with a single cycle of induction chemo-immunotherapy (ICIT). Patients with pathological complete response (pCR) in the re-biopsy enter radioimmunotherapy. Our goal was to study the value of F-18-FDG PET/CT in the prediction of pCR after induction therapy.
METHODS
Patients treated within the CheckRad-CD8 trial that additionally received FDG- PET/CT imaging at the following two time points were included: 3-14 days before (pre-ICIT) and 21-28 days after (post-ICIT) receiving ICIT. Tracer uptake in primary tumors (PT) and suspicious cervical lymph nodes (LN +) was measured using different quantitative parameters on EANM Research Ltd (EARL) accredited PET reconstructions. In addition, mean FDG uptake levels in lymphatic and hematopoietic organs were examined. Percent decrease (Δ) in FDG uptake was calculated for all parameters. Biopsy of the PT post-ICIT acquired after FDG-PET/CT served as reference. The cohort was divided in patients with pCR and residual tumor (ReTu).
RESULTS
Thirty-one patients were included. In ROC analysis, ΔSUVmax PT performed best (AUC = 0.89) in predicting pCR (n = 17), with a decline of at least 60% (sensitivity, 0.77; specificity, 0.93). Residual SUVmax PT post-ICIT performed best in predicting ReTu (n = 14), at a cutpoint of 6.0 (AUC = 0.91; sensitivity, 0.86; specificity, 0.88). Combining two quantitative parameters (ΔSUVmax ≥ 50% and SUVmax PT post-ICIT ≤ 6.0) conferred a sensitivity of 0.81 and a specificity of 0.93 for determining pCR. Background activity in lymphatic organs or uptake in suspected cervical lymph node metastases lacked significant predictive value.
CONCLUSION
FDG-PET/CT can identify patients with pCR after ICIT via residual FDG uptake levels in primary tumors and the related changes compared to baseline. FDG-uptake in LN + had no predictive value.
TRIAL REGISTRY
ClinicalTrials.gov identifier: NCT03426657.
目的
在CheckRad-CD8试验中，局部晚期头颈部鳞状细胞癌患者接受单周期诱导化疗免疫疗法（ICIT）治疗。再次活检出现病理完全缓解（pCR）的患者进入放射免疫治疗阶段。我们的目标是研究F-18-FDG PET/CT在诱导治疗后预测pCR中的价值。
方法
纳入在CheckRad-CD8试验中接受治疗且在以下两个时间点额外接受FDG-PET/CT成像检查的患者：接受ICIT前3-14天（ICIT前）和接受ICIT后21-28天（ICIT后）。使用欧洲核医学协会（EANM）研究有限公司（EARL）认可的PET重建图像上的不同定量参数测量原发肿瘤（PT）和可疑颈部淋巴结（LN+）中的示踪剂摄取情况。此外，还检查了淋巴和造血器官中的平均FDG摄取水平。计算所有参数的FDG摄取减少百分比（Δ）。FDG-PET/CT检查后获取的ICIT后PT活检用作参考。将该队列分为pCR患者和残留肿瘤（ReTu）患者。
结果
纳入31例患者。在ROC分析中，ΔSUVmax PT在预测pCR（n = 17）方面表现最佳（AUC = 0.89），下降至少60%（敏感性为0.77；特异性为0.93）。ICIT后残留的SUVmax PT在预测ReTu（n = 14）方面表现最佳，切点为6.0（AUC = 0.91；敏感性为0.86；特异性为0.88）。结合两个定量参数（ΔSUVmax≥50%且ICIT后SUVmax PT≤6.0）确定pCR的敏感性为0.81，特异性为0.93。淋巴器官中的本底活性或可疑颈部淋巴结转移灶中的摄取缺乏显著预测价值。
结论
FDG-PET/CT可通过原发肿瘤中残留的FDG摄取水平及其与基线相比的相关变化来识别ICIT后出现pCR的患者。LN+中的FDG摄取无预测价值。
试验注册
ClinicalTrials.gov标识符：NCT03426657。
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