正电子发射断层显像标准化摄取值的淋巴结与原发肿瘤比值对鼻咽癌的预后价值：递归划分风险分层分析
Prognostic value of lymph node-to-primary tumor ratio of PET standardized uptake value for nasopharyngeal carcinoma: a recursive partitioning risk stratification analysis.
作者信息
Kong Fang-Fang, Pan Guang-Sen, Ni Meng-Shan, Du Cheng-Run, Hu Chao-Su, Ying Hong-Mei
机构信息
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
Ther Adv Med Oncol. 2024 Feb 18;16:17588359241233235. doi: 10.1177/17588359241233235. eCollection 2024.
BACKGROUND
Induction chemotherapy (IC) combined with concurrent chemoradiotherapy has become the standard treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Data on the prognostic value of the lymph node-to-primary tumor ratio (NTR) of positron emission tomography (PET) standardized uptake value (SUV) for patients treated with IC were limited.
OBJECTIVES
To evaluate the prognostic value of the SUV NTR for patients with LA-NPC treated with IC.
DESIGN
In all, 467 patients with pretreatment 18F-fluorodeoxyglucose PET/computed tomography (CT) scans between September 2017 and November 2020 were retrospectively reviewed.
METHODS
The receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value of SUV NTR. Kaplan-Meier method was used to evaluate survival rates. The recursive partitioning analysis (RPA) was performed to construct a risk stratification model.
RESULTS
The optimal cutoff value of SUV NTR was 0.74. Multivariate analyses showed that SUV NTR and overall stage were independent predictors for distant metastasis-free survival (DMFS) and regional recurrent-free survival (RRFS). Therefore, an RPA model based on the endpoint of DMFS was generated and categorized the patients into three distinct risk groups: RPA I (low risk: SUV NTR < 0.74 and stage III), RPA II (medium risk: SUV NTR < 0.74 and stage IVa, or SUV NTR ⩾ 0.74 and stage III), and RPA III (high risk: SUV NTR ⩾ 0.74 and stage IVa), with a 3-year DMFS of 98.9%, 93.4%, and 84.2%, respectively. ROC analysis showed that the RPA model had superior predictive efficacy than the SUV NTR or overall stage alone.
CONCLUSION
SUV NTR was an independent prognosticator for distant metastasis and regional recurrence in locoregionally advanced NPC. The RPA risk stratification model based on SUV NTR provides improved DMFS and RRFS prediction over the eighth edition of the TNM (Tumor Node Metastasis) staging system.
背景
诱导化疗（IC）联合同步放化疗已成为局部晚期鼻咽癌（LA-NPC）的标准治疗方法。关于接受IC治疗的患者，正电子发射断层扫描（PET）标准化摄取值（SUV）的淋巴结与原发肿瘤比值（NTR）的预后价值的数据有限。
目的
评估SUV NTR对接受IC治疗的LA-NPC患者的预后价值。
设计
回顾性分析2017年9月至2020年11月期间467例接受治疗前18F-氟脱氧葡萄糖PET/计算机断层扫描（CT）的患者。
方法
采用受试者工作特征（ROC）分析确定SUV NTR的最佳截断值。采用Kaplan-Meier法评估生存率。进行递归划分分析（RPA）以构建风险分层模型。
结果
SUV NTR的最佳截断值为0.74。多因素分析表明，SUV NTR和总体分期是无远处转移生存期（DMFS）和无区域复发生存期（RRFS）的独立预测因素。因此，生成了一个基于DMFS终点的RPA模型，并将患者分为三个不同的风险组：RPA I（低风险：SUV NTR < 0.74且为III期）、RPA II（中风险：SUV NTR < 0.74且为IVa期，或SUV NTR ⩾ 0.74且为III期）和RPA III（高风险：SUV NTR ⩾ 0.74且为IVa期），3年DMFS分别为98.9%、93.4%和84.2%。ROC分析表明，RPA模型比单独的SUV NTR或总体分期具有更好的预测效能。
结论
SUV NTR是局部晚期NPC远处转移和区域复发的独立预后因素。基于SUV NTR的RPA风险分层模型在预测DMFS和RRFS方面优于第八版TNM（肿瘤淋巴结转移）分期系统。
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