Ning Yudong, Song Yixuan, He Yuqin, Li Han, Liu Yang, Liu Shaoyan
Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2025 Jun 10;15:1585194. doi: 10.3389/fonc.2025.1585194. eCollection 2025.
To explore an effective method for imaging examinations to evaluate the surgical pathological complete response (PCR) in patients with head and neck squamous cell carcinoma (HNSCC) following neoadjuvant immunochemotherapy (NIC).
HNSCC patients who underwent NIC and subsequent surgery from May 2021 to November 2024 were retrospectively analyzed. All patients underwent imaging examination evaluations, including enhanced computed tomography (CT) and enhanced magnetic resonance (MR) imaging both before and after NIC. The average value of the region of interest (ROI) was extracted from the imaging examinations. Clinical parameter-related data were collected. The paired chi-square test was performed to analyze the differences in complete response (CR) between imaging examinations and pathology according to the response evaluation criteria in solid Tumors version 1.1 (RECISTv1.1). The optimal cutoff values of the adaptive ROI average value were determined using receiver operating characteristic curves (ROC). Binary logistic regression was applied to analyze the relevant clinical factors of PCR.
In total, data from 81 patients with enhanced CT and enhanced MR were included in this study. Significant discrepancies in CR were observed between enhanced CT, MRI, and pathology (21.0% 42.0%, 8.6% 42.0%) (P < 0.05). The ROI average value ratio (before/after NIC) was associated with a better PCR. Specifically, ROI average value ratio ≥ 1.18 on enhanced CT (odds ratio [OR] 125.306,95% confidence interval [CI] 5.545-2831.633,P <0.001; PCR 80.6% 11.1%) or ROI value ratio ≥ 1.06 on T2-weighted image of enhanced MR (OR 144.822,95%CI 9.271-2262.326,P < 0.001; PCR 90.3% 12.0%) was noted.
Based on RECIST v 1.1, discrepancies in PCR were found between imaging examinations and surgical pathology of HNSCC after NIC. The ROI average value ratio (before/after NIC) was associated with a better PCR, with an enhanced CT ROI average value ratio ≥ 1.18 or the ROI average value ratio ≥ 1.06. Thus, RECIST v1.1 was demonstrated to be an inaccurate assessment method for PCR in HNSCC after NIC. The ROI average value ratio may have good diagnostic efficacy for PCR in HNSCC patients receiving NIC.
探索一种有效的影像学检查方法，以评估头颈部鳞状细胞癌（HNSCC）患者在新辅助免疫化疗（NIC）后手术病理完全缓解（PCR）情况。
回顾性分析2021年5月至2024年11月接受NIC及后续手术的HNSCC患者。所有患者在NIC前后均接受影像学检查评估，包括增强计算机断层扫描（CT）和增强磁共振（MR）成像。从影像学检查中提取感兴趣区域（ROI）的平均值。收集临床参数相关数据。根据实体瘤疗效评价标准第1.1版（RECISTv1.1），采用配对卡方检验分析影像学检查与病理在完全缓解（CR）方面的差异。使用受试者工作特征曲线（ROC）确定适应性ROI平均值的最佳截断值。应用二元逻辑回归分析PCR的相关临床因素。
本研究共纳入81例增强CT和增强MR患者的数据。在增强CT、MRI与病理之间观察到CR存在显著差异（21.0%对42.0%，8.6%对42.0%）（P<0.05）。ROI平均值比（NIC前后）与更好的PCR相关。具体而言，增强CT上ROI平均值比≥1.18（优势比[OR]125.306，95%置信区间[CI]5.545 - 2831.633，P<0.001；PCR为80.6%对11.1%）或增强MR的T2加权图像上ROI值比≥1.06（OR 144.822，95%CI 9.271 - 2262.326，P<0.001；PCR为90.3%对12.0%）。
基于RECIST v 1.1，发现NIC后HNSCC的影像学检查与手术病理在PCR方面存在差异。ROI平均值比（NIC前后）与更好的PCR相关，增强CT的ROI平均值比≥1.18或ROI平均值比≥1.06。因此，RECIST v1.1被证明是NIC后HNSCC中PCR的不准确评估方法。ROI平均值比可能对接受NIC的HNSCC患者的PCR具有良好的诊断效能。
