Benefit of [18F]-FDG PET/CT for treatment-naïve nasopharyngeal carcinoma
Tóm tắt
To test the advantages of positron emission tomography and computed tomography (PET/CT) for diagnosing lymph nodes and staging nasopharyngeal carcinoma and to investigate its benefits for survival and treatment decisions. The performance of PET/CT and magnetic resonance imaging (MRI) in diagnosis was compared based on 460 biopsied lymph nodes. Using the propensity matching method, survival differences of T3N1M0 patients with (n = 1093) and without (n = 1377) PET/CT were compared in diverse manners. A radiologic score model was developed and tested in a subset of T3N1M0 patients. PET/CT performed better than MRI with higher sensitivity, accuracy, and area under the receiver operating characteristic curve (96.7% vs. 88.5%, p < 0.001; 88.0% vs. 81.1%, p < 0.001; 0.863 vs. 0.796, p < 0.05) in diagnosing lymph nodes. Accordingly, MRI-staged T3N0-3M0 patients showed nondifferent survival rates, as they were the same T3N1M0 if staged by PET/CT. In addition, patients staged by PET/CT and MRI showed higher survival rates than those staged by MRI alone (p < 0.05), regardless of the Epstein-Barr virus DNA load. Interestingly, SUVmax-N, nodal necrosis, and extranodal extension were highly predictive of survival. The radiologic score model based on these factors performed well in risk stratification with a C-index of 0.72. Finally, induction chemotherapy showed an added benefit (p = 0.006) for the high-risk patients selected by the model but not for those without risk stratification (p = 0.78). PET/CT showed advantages in staging nasopharyngeal carcinoma due to a more accurate diagnosis of lymph nodes and this contributed to a survival benefit. PET/CT combined with MRI provided prognostic factors that could identify high-risk patients and guide individualized treatment.
Tài liệu tham khảo
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021. https://doi.org/10.3322/caac.21660.
Yen TC, Chang JT, Ng SH, Chang YC, Chan SC, Lin KJ, et al. The value of 18F-FDG PET in the detection of stage M0 carcinoma of the nasopharynx. J Nucl Med. 2005;46:405–10.
Tang LQ, Chen QY, Fan W, Liu H, Zhang L, Guo L, et al. Prospective study of tailoring whole-body dual-modality [18F]fluorodeoxyglucose positron emission tomography/computed tomography with plasma Epstein-Barr virus DNA for detecting distant metastasis in endemic nasopharyngeal carcinoma at initial staging. J Clin Oncol. 2013;31:2861–9. https://doi.org/10.1200/JCO.2012.46.0816.
Xiao BB, Chen QY, Sun XS, Li JB, Luo DH, Sun R, et al. Low value of whole-body dual-modality [18f]fluorodeoxyglucose positron emission tomography/computed tomography in primary staging of stage I-II nasopharyngeal carcinoma: a nest case-control study. Eur Radiol. 2021. https://doi.org/10.1007/s00330-020-07478-1.
Zhang LN, Gao YH, Lan XW, Tang J, Su Z, Ma J, et al. Propensity score matching analysis of cisplatin-based concurrent chemotherapy in low risk nasopharyngeal carcinoma in the intensity-modulated radiotherapy era. Oncotarget. 2015;6:44019–29. https://doi.org/10.18632/oncotarget.5806.
Sun Y, Li W-F, Chen N-Y, Zhang N, Hu G-Q, Xie F-Y, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016;17:1509–20. https://doi.org/10.1016/s1470-2045(16)30410-7.
Zhang Y, Chen L, Hu GQ, Zhang N, Zhu XD, Yang KY, et al. Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma. N Engl J Med. 2019;381:1124–35. https://doi.org/10.1056/NEJMoa1905287.
Cao SM, Yang Q, Guo L, Mai HQ, Mo HY, Cao KJ, et al. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase III multicentre randomised controlled trial. Eur J Cancer. 2017;75:14–23. https://doi.org/10.1016/j.ejca.2016.12.039.
Lan XW, Xiao Y, Zou XB, Zhang XM, OuYang PY, Xie FY. Outcomes of adding induction chemotherapy to concurrent chemoradiotherapy for stage T3N0-1 nasopharyngeal carcinoma: a propensity-matched study. Onco Targets Ther. 2017;10:3853–60. https://doi.org/10.2147/OTT.S133917.
Xu C, Zhang S, Li WF, Chen L, Mao YP, Guo Y, et al. Selection and validation of induction chemotherapy beneficiaries among patients with T3N0, T3N1, T4N0 nasopharyngeal carcinoma using Epstein-Barr virus DNA: a joint analysis of real-world and clinical trial data. Front Oncol. 2019;9:1343. https://doi.org/10.3389/fonc.2019.01343.
van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology. 1990;177:379–84. https://doi.org/10.1148/radiology.177.2.2217772.
Mao Y, Wang S, Lydiatt W, Shah JP, Colevas AD, Lee AWM, et al. Unambiguous advanced radiologic extranodal extension determined by MRI predicts worse outcomes in nasopharyngeal carcinoma: potential improvement for future editions of N category systems. Radiother Oncol. 2021;157:114–21. https://doi.org/10.1016/j.radonc.2021.01.015.
Lan M, Huang Y, Chen CY, Han F, Wu SX, Tian L, et al. Prognostic value of cervical nodal necrosis in nasopharyngeal carcinoma: analysis of 1800 patients with positive cervical nodal metastasis at MR imaging. Radiology. 2015;276:536–44. https://doi.org/10.1148/radiol.15141251.
Koshy M, Paulino AC, Howell R, Schuster D, Halkar R, Davis LW. F-18 FDG PET-CT fusion in radiotherapy treatment planning for head and neck cancer. Head Neck. 2005;27:494–502. https://doi.org/10.1002/hed.20179.
Ng SH, Chan SC, Yen TC, Chang JT, Liao CT, Ko SF, et al. Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up. Eur J Nucl Med Mol Imaging. 2009;36:12–22. https://doi.org/10.1007/s00259-008-0918-7.
Ryu IS, Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, et al. Impact of (18)F-FDG PET/CT staging on management and prognostic stratification in head and neck squamous cell carcinoma: a prospective observational study. Eur J Cancer. 2016;63:88–96. https://doi.org/10.1016/j.ejca.2016.05.002.
Adams S, Baum RP, Stuckensen T, Bitter K, Hor G. Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med. 1998;25:1255–60. https://doi.org/10.1007/s002590050293.
Chen WS, Li JJ, Hong L, Xing ZB, Wang F, Li CQ. Comparison of MRI, CT and 18F-FDG PET/CT in the diagnosis of local and metastatic of nasopharyngeal carcinomas: an updated meta analysis of clinical studies. Am J Transl Res. 2016;8:4532–47.
Cacicedo J, Fernandez I, Del Hoyo O, Dolado A, Gomez-Suarez J, Hortelano E, et al. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis. Eur J Nucl Med Mol Imaging. 2015;42:1378–89. https://doi.org/10.1007/s00259-015-3071-0.
Scott AM, Gunawardana DH, Bartholomeusz D, Ramshaw JE, Lin P. PET changes management and improves prognostic stratification in patients with head and neck cancer: results of a multicenter prospective study. J Nucl Med. 2008;49:1593–600. https://doi.org/10.2967/jnumed.108.053660.
DG P SS. Head and neck cancers, version 3.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021;18:873–98.
Hung TM, Fan KH, Kang CJ, Huang SF, Lin CY, Ho AT, et al. Lymph node-to-primary tumor standardized uptake value ratio on PET predicts distant metastasis in nasopharyngeal carcinoma. Oral Oncol. 2020;110:104756. https://doi.org/10.1016/j.oraloncology.2020.104756.
Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, Sun Y, et al. Concurrent chemoradiotherapy with/without induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma: long-term results of phase 3 randomized controlled trial. Int J Cancer. 2019;145:295–305. https://doi.org/10.1002/ijc.32099.