初治放化疗治疗的口咽癌中基线期和治疗中期 FDG-PET 的预后和预测价值及 HPV 状态的影响：文献复习及新出现的作用

Prognostic and predictive values of baseline and mid-treatment FDG-PET in oropharyngeal carcinoma treated with primary definitive (chemo)radiation and impact of HPV status: Review of current literature and emerging roles.

机构信息

Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia.

South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.

出版信息

Radiother Oncol. 2023 Jul;184:109686. doi: 10.1016/j.radonc.2023.109686. Epub 2023 May 2.

DOI:10.1016/j.radonc.2023.109686

PMID:37142128

Abstract

BACKGROUND AND PURPOSE

This study provides a review of the literature assessing whether semiquantitative PET parameters acquired at baseline and/or during definitive (chemo)radiotherapy ("prePET" and "iPET") can predict survival outcomes in patients with oropharyngeal squamous cell carcinoma (OPC), and the impact of human papilloma virus (HPV) status.

MATERIAL AND METHODS

A literature search was carried out using PubMed and Embase between 2001 to 2021 in accordance with PRISMA.

RESULTS

The analysis included 22 FDG-PET/CT studies [1-22], 19 pre-PET and 3 both pre-PET and iPET, The analysis involved 2646 patients, of which 1483 are HPV-positive (17 studies: 10 mixed and 7 HPV-positive only), 589 are HPV-negative, and 574 have unknown HPV status. Eighteen studies found significant correlations of survival outcomes with pre-PET parameters, most commonly primary or "Total" (combined primary and nodal) metabolic tumour volume and/or total lesional glycolysis. Two studies could not establish significant correlations and both employed SUVmax only. Two studies also could not establish significant correlations when taking into account of the HPV-positive population only. Because of the heterogeneity and lack of standardized methodology, no conclusions on optimal cut-off values can be drawn. Ten studies specifically evaluated HPV-positive patients: five showed positive correlation of pre-PET parameters and survival outcomes, but four of these studies did not include advanced T or N staging in multivariate analysis, and two studies only showed positive correlations after excluding high risk patients with smoking history or adverse CT features. Two studies found that prePET parameters predicted treatment outcomes only in HPV-negative but not HPV-positive patients. Two studies found that iPET parameters could predict outcomes in HPV-positive patients but not prePET parameters.

CONCLUSION

The current literature supports high pre-treatment metabolic burden prior to definitive (chemo)radiotherapy can predict poor treatment outcomes for HPV-negative OPC patients. Evidence is conflicting and currently does not support correlation in HPV-positive patients.

摘要

背景与目的

本研究对评估口咽鳞癌（OPC）患者在接受根治性（放化疗）前后的半定量 PET 参数（“预 PET”和“iPET”）能否预测生存结局的文献进行综述，并探讨 HPV 状态的影响。

材料与方法

根据 PRISMA 原则，于 2001 年至 2021 年期间在 PubMed 和 Embase 上进行文献检索。

结果

分析共纳入 22 项 FDG-PET/CT 研究[1-22]，其中 19 项为预 PET，3 项同时包含预 PET 和 iPET。分析共纳入 2646 例患者，其中 1483 例 HPV 阳性（17 项研究：10 项混合研究，7 项 HPV 阳性仅），589 例 HPV 阴性，574 例 HPV 状态未知。18 项研究发现生存结局与预 PET 参数存在显著相关性，最常见的是原发或“总”（原发灶和淋巴结）代谢肿瘤体积和/或总病灶糖酵解。两项研究未发现显著相关性，且均仅采用 SUVmax。当仅考虑 HPV 阳性人群时，两项研究也未发现显著相关性。由于异质性和缺乏标准化方法，无法得出最佳截断值的结论。有 10 项研究专门评估了 HPV 阳性患者：其中 5 项研究表明预 PET 参数与生存结局存在正相关，但其中 4 项研究在多变量分析中未纳入晚期 T 或 N 分期，另外 2 项研究仅在排除有吸烟史或不良 CT 特征的高危患者后才显示出正相关。两项研究发现，预 PET 参数仅能预测 HPV 阴性患者的治疗结局，而不能预测 HPV 阳性患者的治疗结局。两项研究发现 iPET 参数可预测 HPV 阳性患者的结局，但预 PET 参数不行。