原发肿瘤和淋巴结的总病变糖酵解是口咽癌患者远处转移发生的有力预测指标，在自动勾画的病变中得到了独立验证。
Total lesion glycolysis of primary tumor and lymphnodes is a strong predictor for development of distant metastases in oropharyngeal carcinoma patients with independent validation in automatically delineated lesions.
作者信息
Zschaeck Sebastian, Hajiyianni Marina, Hausmann Patrick, Nikulin Pavel, Kukuk Emily, Furth Christian, Cegla Paulina, Lombardo Elia, Kazmierska Joanna, Holzgreve Adrien, Strouthos Iosif, Stromberger Carmen, Belka Claus, Baumann Michael, Krause Mechthild, Landry Guillaume, Cholewinski Witold, Kotzerke Jorg, Zips Daniel, van den Hoff Jörg, Hofheinz Frank
机构信息
Department of Radiation Oncology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany.
出版信息
Cancer Imaging. 2025 Feb 21;25(1):18. doi: 10.1186/s40644-025-00836-6.
BACKGROUND
Oropharyngeal carcinomas are characterized by an increasing incidence and a relatively good prognosis. Nonetheless, a considerable number of patients develops metachronous distant metastases; identification of these patients is an urgent medical need.
METHODS
This is a retrospective multicenter evaluation of 431 patients. All patients underwent [F]-FDG positron emission tomography (PET). The cohort was split into an explorative group (n = 366) and a validation group (n = 65). Lesions were manually delineated in the explorative group and automatically delineated by a convolutional neuronal network (CNN) in the validation group. Quantitative PET parameters standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated for primary tumors () and tumor plus lymphnodes (). Association of parameters with freedom from distant metastases (FFDM) and overall survival (OS) was tested by cox regression analyses.
RESULTS
In the explorative group, univariate analyses revealed an association of metric MTV (p = 0.022), MTV (p < 0.001) and TLG (p < 0.001) with FFDM, binarized parameters were also associated with FFDM (p < 0.001 and p = 0.002). Bootstrap analyses revealed a significantly better association of TLG compared to TLG with FFDM (p = 0.02). MTV and TLG remained significantly associated with FFDM upon multivariate testing (p = 0.002, p = 0.031, respectively). In the validation group, the cutoff value for TLG but not for TLG was significantly associated with FFDM (HR = 3.1, p = 0.045). Additional analyses with manually delineated contours of the validation cohort revealed a similar effect (HR = 3.47, p = 0.026). No considerable differences between HPV positive and negative disease were observed.
CONCLUSIONS
TLG is a promising biomarker to select OPC patients with high risk for metachronous distant metastases.
背景
口咽癌的特点是发病率不断上升且预后相对较好。尽管如此，仍有相当数量的患者发生异时性远处转移；识别这些患者是一项迫切的医疗需求。
方法
这是一项对431例患者的回顾性多中心评估。所有患者均接受了[F]-FDG正电子发射断层扫描（PET）。该队列被分为探索组（n = 366）和验证组（n = 65）。在探索组中手动勾勒病变，在验证组中由卷积神经网络（CNN）自动勾勒病变。计算原发性肿瘤（）和肿瘤加淋巴结（）的定量PET参数标准化摄取值（SUV）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。通过cox回归分析测试参数与无远处转移（FFDM）和总生存期（OS）的相关性。
结果
在探索组中，单因素分析显示，指标MTV（p = 0.022）、MTV（p < 0.001）和TLG（p < 0.001）与FFDM相关，二值化参数也与FFDM相关（p < 0.001和p = 0.002）。自举分析显示，与TLG相比，TLG与FFDM的相关性显著更好（p = 0.02）。多因素测试时，MTV和TLG与FFDM仍显著相关（分别为p = 0.002，p = 0.031）。在验证组中，TLG而非TLG的临界值与FFDM显著相关（HR = 3.1，p = 0.045）。对验证队列手动勾勒轮廓的额外分析显示了类似的效果（HR = 3.47，p = 0.026）。未观察到HPV阳性和阴性疾病之间的显著差异。
结论
TLG是一种有前景的生物标志物，可用于筛选有异时性远处转移高风险的口咽癌患者。
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