肿瘤内代谢异质性的治疗中期变化与口咽鳞状细胞癌患者的预后相关。
Mid-treatment changes in intra-tumoural metabolic heterogeneity correlate to outcomes in oropharyngeal squamous cell carcinoma patients.
作者信息
Trada Yuvnik, Lee Mark T, Jameson Michael G, Chlap Phillip, Keall Paul, Moses Daniel, Lin Peter, Fowler Allan
机构信息
Department of Radiation Oncology, Calvary Mater Newcastle, Edith St, Waratah, 2298, NSW, Australia.
Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
出版信息
EJNMMI Res. 2025 Apr 1;15(1):31. doi: 10.1186/s13550-025-01226-6.
BACKGROUND
This study evaluated mid-treatment changes in intra-tumoural metabolic heterogeneity and quantitative FDG-PET/CT imaging parameters and correlated the changes with treatment outcomes in oropharyngeal squamous cell cancer (OPSCC) patients. 114 patients from two independent cohorts underwent baseline and mid-treatment (week 3) FDG-PET. Standardized uptake value maximum (SUV), standardized uptake value mean (SUV), metabolic tumour volume (MTV), and total lesional glycolysis (TLG) were measured. Intra-tumoural metabolic heterogeneity was quantified as the area under a cumulative SUV-volume histogram curve (AUC-CSH). Baseline and relative change (%∆) in imaging features were correlated to locoregional recurrence free survival (LRRFS) using multivariate Cox regression analysis. Patients were stratified into three risk groups utilising ∆AUC-CSH and known prognostic features, then compared using Kaplan-Meier analysis.
RESULTS
Median follow up was 39 months. 18% of patients developed locoregional recurrence at 2 years. A decrease in heterogeneity (∆AUC-CSH: 24%) was observed mid-treatment. There was no statistically significant difference in tumour heterogeneity (AUC-CSH) at baseline (p = 0.134) and change at week 3 (p = 0.306) between p16 positive and p16 negative patients. Baseline imaging features did not correlate to LRRFS. However, ∆MTV (aHR 1.04; 95% CI 1.03-1.06; p < 0.001) and ∆AUC-CSH (aHR 0.96; 95% CI 0.94-0.98; p = 0.004) were correlated to LRRFS. Stratification using ∆AUC-CSH and p16 status into three groups showed significant differences in LRR (2 year LRRFS 94%, 79%, 17%; log rank p < 0.001). Stratification using ∆AUC-CSH and ∆MTV into three groups showed significant differences in LRR (2 year LRRFS 93%, 70%, 17%; log rank p < 0.001).
CONCLUSION
Mid-treatment changes in intra-tumoural FDG-PET/CT heterogeneity correlated with treatment outcomes in OPSCC and may help with response prediction. These findings suggest potential utility in designing future risk adaptive clinical trials.
背景
本研究评估了口咽鳞状细胞癌（OPSCC）患者肿瘤内代谢异质性和定量FDG-PET/CT成像参数的治疗中期变化，并将这些变化与治疗结果相关联。来自两个独立队列的114例患者接受了基线和治疗中期（第3周）的FDG-PET检查。测量了标准化摄取值最大值（SUV）、标准化摄取值平均值（SUV）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。肿瘤内代谢异质性被量化为累积SUV-体积直方图曲线下面积（AUC-CSH）。使用多变量Cox回归分析将成像特征的基线和相对变化（%∆）与无局部区域复发生存率（LRRFS）相关联。利用∆AUC-CSH和已知的预后特征将患者分为三个风险组，然后使用Kaplan-Meier分析进行比较。
结果
中位随访时间为39个月。18%的患者在2年时出现局部区域复发。治疗中期观察到异质性降低（∆AUC-CSH：24%）。p16阳性和p16阴性患者在基线时的肿瘤异质性（AUC-CSH）（p = 0.134）和第3周时的变化（p = 0.306）无统计学显著差异。基线成像特征与LRRFS无关。然而，∆MTV（风险比1.04；95%置信区间1.03 - 1.06；p < 0.001）和∆AUC-CSH（风险比0.96；95%置信区间0.94 - 0.98；p = 0.004）与LRRFS相关。使用∆AUC-CSH和p16状态分为三组显示局部区域复发有显著差异（2年LRRFS分别为94%、79%、17%；对数秩检验p < 0.001）。使用∆AUC-CSH和∆MTV分为三组显示局部区域复发有显著差异（2年LRRFS分别为93%、70%、17%；对数秩检验p < 0.001）。
结论
肿瘤内FDG-PET/CT异质性的治疗中期变化与OPSCC的治疗结果相关，可能有助于反应预测。这些发现提示在设计未来的风险适应性临床试验中具有潜在用途。
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