Cheng Nai-Ming, Lin Chien-Yu, Liao Chun-Ta, Tsan Din-Li, Ng Shu-Hang, Yen Tzu-Chen
Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Shin St., Kueishan District, Taoyuan City, 333, Taiwan.
Department of Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan.
EJNMMI Res. 2023 Apr 3;13(1):25. doi: 10.1186/s13550-023-00965-8.
Osteoradionecrosis (ORN) of the jaw requires a differential diagnosis to exclude cancer recurrence. Here, we sought to develop a scoring system comprising F-FDG PET/CT parameters for distinguishing between the two conditions in patients with oral squamous cell carcinoma (OSCC).
The study consisted of 103 OSCC patients with suspected ORN of the jaw. All participants underwent F-FDG PET/CT imaging within 6 months of diagnostic histopathology. Following extraction of PET parameters, we identified clinical and imaging predictors of mandibular recurrence-free survival (MRFS) using receiver operating characteristic curve analysis and multivariate Cox regression models.
The results of histopathology revealed mandibular cancer recurrence in 24 patients (23.3%). Multivariate Cox regression analyses identified an age at diagnosis ≤ 52 years (P = 0.013), a location of the SUVmax voxel with soft tissue predominance (P = 0.019), and mandibular total lesion glycolysis (TLG) > 62.68 g (P < 0.001) as independent risk factors for MRFS. A scoring system was devised with scores from 0 (no risk factor) to 3 (presence of all three risk factors). High-risk patients with a score of 2-3 compared with score of 0-1 had a significantly higher likelihood of mandibular cancer recurrence (hazard ratio: 32.50, 95% confidence interval: 8.51-124.18, P < 0.001). The scoring system had a sensitivity of 87.50%, a specificity of 82.28%, and an accuracy of 83.50% for identifying mandibular cancer recurrence.
The scoring system of our study is clinically useful for identifying mandibular cancer recurrence in patients with suspected ORN of the jaw.
颌骨放射性骨坏死（ORN）需要进行鉴别诊断以排除癌症复发。在此，我们试图开发一种包含F-FDG PET/CT参数的评分系统，用于区分口腔鳞状细胞癌（OSCC）患者的这两种情况。
该研究纳入了103例疑似颌骨ORN的OSCC患者。所有参与者在诊断性组织病理学检查后的6个月内接受了F-FDG PET/CT成像。提取PET参数后，我们使用受试者工作特征曲线分析和多变量Cox回归模型确定了下颌无复发生存期（MRFS）的临床和影像预测因素。
组织病理学结果显示24例患者（23.3%）存在下颌骨癌复发。多变量Cox回归分析确定诊断时年龄≤52岁（P = 0.013）、SUVmax体素位于软组织为主的部位（P = 0.019）以及下颌骨总病变糖酵解（TLG）>62.68 g（P < 0.001）是MRFS的独立危险因素。设计了一种评分系统，分数从0（无危险因素）到3（存在所有三个危险因素）。与0-1分的低风险患者相比，2-3分的高风险患者下颌骨癌复发的可能性显著更高（风险比：32.50，95%置信区间：8.51-124.18，P < 0.001）。该评分系统识别下颌骨癌复发的敏感性为87.50%，特异性为82.28%，准确性为83.50%。
我们研究的评分系统在临床上有助于识别疑似颌骨ORN患者的下颌骨癌复发。
