Tumor Glucose Metabolism and Its Heterogeneity on F-18 FDG PET/CT Provide Better Prognostication in Nonmetastatic Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. F-18 FDG PET/CT
2.3. Image Analysis
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Prognostic Values of Clinical Parameters and Metabolic Parameters of F-18 FDG PET/CT
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | All Patients (n = 90) |
---|---|
Age, mean ± SD, years | 57.3 ± 8.6 |
Sex, n (%) | |
Male | 72 (80.0) |
Female | 18 (20.0) |
ECOG, n (%) | |
0 | 33 (36.7) |
1 | 57 (63.3) |
Overall stage, n (%) | |
Stage I | 61 (67.8) |
Stage II | 11 (12.2) |
Stage III | 18 (20.0) |
Tumor stage, n (%) | |
T1 | 19 (21.1) |
T2 | 45 (50.0) |
T3 | 8 (8.9) |
T4 | 18 (20.0) |
Nodal stage, n (%) | |
N0 | 9 (10.0) |
N1 | 68 (75.6) |
N2 | 12 (13.3) |
N3 | 1 (1.1) |
Smoking history, n (%) | |
Never or ≤10 pack-years | 52 (57.8) |
>10 pack-years | 38 (42.2) |
Primary treatment, n (%) | |
Surgery | 77 (85.6) |
Surgical approach, n (%) | |
Open | 37 (48.1) |
Robotic | 40 (51.9) |
Resection margin, n (%) | |
Negative | 52 (67.5) |
Positive | 25 (32.5) |
Extracapsular spread, n (%) | |
Negative | 33 (42.9) |
Positive | 44 (57.1) |
Lymphovascular invasion, n (%) | |
Negative | 52 (67.5) |
Positive | 25 (32.5) |
Perineural invasion, n (%) | |
Negative | 66 (85.7) |
Positive | 11 (14.3) |
Adjuvant therapy, n (%) | |
None | 6 (7.8) |
Radiotherapy | 15 (19.5) |
Chemoradiotherapy | 56 (72.7) |
Radiotherapy | 13 (14.4) |
Chemotherapy, n (%) | |
Yes | 76 (84.4) |
No | 14 (15.6) |
SUVmax-TLR, median (range) | 5.4 (1.5–11.0) |
MTV, median (range), mL | 7.9 (0.3–61.5) |
TLG-TLR, median (range) | 26.4 (1.3–243.7) |
CV, mean ± SD, % | 27.8 ± 6.3 |
Characteristic | Hazard Ratio (95% CI) | p * |
---|---|---|
Univariate Analysis | ||
Age | 0.04 | |
≤57 years | ||
>57 years | 3.21 (1.03–9.95) | |
Sex | 0.44 | |
Male | ||
Female | 0.56 (0.13–2.45) | |
ECOG | 0.13 | |
0 | ||
1 | 2.65 (0.75–9.30) | |
Smoking history | 0.24 | |
Never or ≤10 pack-years | ||
>10 pack-years | 1.80 (0.67–4.84) | |
Overall stage | <0.001 | |
I–II | ||
III | 7.21 (2.67–19.45) | |
Primary treatment | 0.004 | |
Surgery | ||
Radiotherapy | 4.37 (1.58–12.07) | |
Chemotherapy | 0.73 | |
Yes | 1.30 (0.29–5.70) | |
No | ||
SUVmax-TLR | 0.02 | |
≤4.8 | ||
>4.8 | 11.03 (1.46–83.53) | |
MTV | <0.001 | |
≤17.1 mL | ||
>17.1 mL | 6.81 (2.54–18.27) | |
TLG-TLR | <0.001 | |
≤84.2 | ||
>84.2 | 8.34 (2.97–23.45) | |
CV | 0.007 | |
≤27.9% | ||
>27.9% | 16.54 (2.18–125.3) | |
Multivariate analysis including age, overall stage, SUVmax-TLR, and primary treatment (PFS model 1) | ||
Age (≤57 vs. >57 years) | 4.08 (1.29–12.93) | 0.02 |
Overall stage (I–II vs. III) | 5.36 (1.69–17.03) | 0.004 |
Primary treatment (surgery vs. radiotherapy) | 1.78 (0.53–5.97) | 0.35 |
SUVmax-TLR (≤4.8 vs. >4.8) | 9.92 (1.26–77.86) | 0.03 |
Multivariate analysis including age, overall stage, MTV, and primary treatment (PFS model 2) | ||
Age (≤57 vs. >57 years) | 3.67 (1.16–11.55) | 0.03 |
Overall stage (I–II vs. III) | 3.73 (1.15–12.04) | 0.03 |
Primary treatment (surgery vs. radiotherapy) | 1.58 (0.43–5.88) | 0.49 |
MTV (≤17.1 vs. >17.1 mL) | 3.30 (0.90–12.04) | 0.07 |
Multivariate analysis including age, overall stage, TLG-TLR, and primary treatment (PFS model 3) | ||
Age (≤57 vs. >57 years) | 4.66 (1.39–15.62) | 0.01 |
Overall stage (I–II vs. III) | 3.63 (1.13–11.64) | 0.03 |
Primary treatment (surgery vs. radiotherapy) | 1.92 (0.56–6.63) | 0.30 |
TLG-TLR (≤84.2 vs. >84.2) | 3.80 (0.94–15.30) | 0.06 |
Multivariate analysis including age, overall stage, CV, and primary treatment (PFS model 4) | ||
Age (≤57 vs. >57 years) | 5.13 (1.55–16.95) | 0.007 |
Overall stage (I–II vs. III) | 6.62 (1.86–23.63) | 0.004 |
Primary treatment (surgery vs. radiotherapy) | 1.29 (0.36–4.60) | 0.70 |
CV (≤27.9 vs. >27.9%) | 16.77 (2.05–136.96) | 0.009 |
Characteristic | Hazard Ratio (95% CI) | p * |
---|---|---|
Univariate Analysis | ||
Age | 0.02 | |
≤57 years | ||
>57 years | 5.94 (1.32–26.80) | |
Sex | 0.66 | |
Male | ||
Female | 0.71 (0.16–3.20) | |
ECOG | 0.12 | |
0 | ||
1 | 3.32 (0.74–14.99) | |
Smoking history | 0.36 | |
Never or ≤10 pack-years | ||
>10 pack-years | 1.66 (0.56–4.94) | |
Overall stage | <0.001 | |
I–II | ||
III | 8.29 (2.70–25.47) | |
Primary treatment | 0.001 | |
Surgery | ||
Radiotherapy | 6.29 (2.10–18.79) | |
Chemotherapy | 0.95 | |
Yes | 0.95 (0.21–4.31) | |
No | ||
SUVmax-TLR | 0.02 | |
≤4.9 | ||
>4.9 | 10.38 (1.35–79.89) | |
MTV | 0.002 | |
≤17.1 mL | ||
>17.1 mL | 5.55 (1.86–16.59) | |
TLG-TLR | 0.001 | |
≤50.0 | ||
>50.0 | 6.48 (2.12–19.86) | |
CV | 0.01 | |
≤27.9% | ||
>27.9% | 12.64 (1.64–97.24) | |
Multivariate analysis including age, overall stage, SUVmax-TLR, and primary treatment (OS model 1) | ||
Age (≤57 vs. >57 years) | 8.24 (1.75–38.85) | 0.008 |
Overall stage (I–II vs. III) | 4.57 (1.20–17.38) | 0.03 |
Primary treatment (surgery vs. radiotherapy) | 3.23 (0.85–12.27) | 0.08 |
SUVmax-TLR (≤4.9 vs. >4.9) | 10.16 (1.29–79.70) | 0.03 |
Multivariate analysis including age, overall stage, MTV, and primary treatment (OS model 2) | ||
Age (≤57 vs. >57 years) | 7.55 (1.59–35.88) | 0.01 |
Overall stage (I–II vs. III) | 3.99 (1.08–14.79) | 0.04 |
Primary treatment (surgery vs. radiotherapy) | 2.83 (0.68–11.76) | 0.15 |
MTV (≤17.1 vs. >17.1 mL) | 2.74 (0.67–11.13) | 0.16 |
Multivariate analysis including age, overall stage, TLG-TLR, and primary treatment (OS model 3) | ||
Age (≤57 vs. >57 years) | 7.32 (1.56–34.28) | 0.01 |
Overall stage (I–II vs. III) | 3.51 (0.94–13.11) | 0.06 |
Primary treatment (surgery vs. radiotherapy) | 3.29 (0.88–12.31) | 0.08 |
TLG-TLR (≤50.0 vs. >50.0) | 3.28 (0.94–11.42) | 0.06 |
Multivariate analysis including age, overall stage, CV, and primary treatment (OS model 4) | ||
Age (≤57 vs. >57 years) | 8.17 (1.73–38.54) | 0.008 |
Overall stage (I–II vs. III) | 5.42 (1.25–23.53) | 0.02 |
Primary treatment (surgery vs. radiotherapy) | 2.11 (0.50–8.85) | 0.31 |
CV (≤27.9 vs. >27.9%) | 10.64 (1.27–89.43) | 0.03 |
Characteristic | Surgically Treated Patients (n = 77) |
---|---|
Age, mean ± SD, years | 57.4 ± 8.4 |
Sex, n (%) | |
Male | 64 (83.1) |
Female | 13 (16.9) |
ECOG, n (%) | |
0 | 30 (39.0) |
1 | 47 (61.0) |
Smoking history, n (%) | |
Never or ≤10 pack-years | 42 (54.5) |
>10 pack-years | 35 (45.5) |
Overall stage, n (%) | |
Stage I | 58 (75.3) |
Stage II | 8 (10.4) |
Stage III | 11 (14.3) |
Tumor stage, n (%) | |
T1 | 16 (20.8) |
T2 | 43 (55.8) |
T3 | 7 (9.1) |
T4 | 11 (14.3) |
Nodal stage, n (%) | |
N0 | 7 (9.1) |
N1 | 64 (83.1) |
N2 | 5 (6.5) |
N3 | 1 (1.3) |
Chemotherapy, n (%) | |
Yes | 63 (81.8) |
No | 14 (18.2) |
SUVmax-TLR, median (range) | 5.3 (1.5–11.0) |
MTV, median (range), mL | 7.0 (0.3–46.1) |
TLG-TLR, median (range) | 23.1 (1.3–243.7) |
CV, mean ± SD, % | 27.5 ± 6.3 |
Characteristic | Hazard Ratio (95% CI) | p * |
---|---|---|
Univariate Analysis | ||
Age | 0.22 | |
≤57 years | ||
>57 years | 2.32 (0.60–8.96) | |
Sex | NR | |
Male | ||
Female | NR | |
ECOG | 0.23 | |
0 | ||
1 | 2.61 (0.55–12.29) | |
Smoking history | 0.36 | |
Never or ≤10 pack-years | ||
>10 pack-years | 1.82 (0.51–6.44) | |
Overall stage | 0.012 | |
I–II | ||
III | 5.08 (1.43–18.05) | |
Surgical approach | 0.41 | |
Open | ||
Robotic | 0.59 (0.17–2.09) | |
Resection margin | 0.21 | |
Negative | ||
Positive | 2.23 (0.64–7.69) | |
Extracapsular spread | 0.15 | |
Negative | ||
Positive | 3.10 (0.66–14.58) | |
Lymphovascular invasion | 0.01 | |
Negative | ||
Positive | 5.57 (1.44–21.55) | |
Perineural invasion | 0.14 | |
Negative | ||
Positive | 2.75 (0.71–10.63) | |
Adjuvant therapy | ||
None | ||
Radiotherapy | 1.16 (0.12–11.19) | 0.90 |
Chemoradiotherapy | 0.61 (0.07–5.05) | 0.65 |
Chemotherapy | 0.86 | |
Yes | 0.87 (0.18–4.08) | |
No | ||
SUVmax-TLR | 0.003 | |
≤7.1 | ||
>7.1 | 7.05 (1.97–25.17) | |
MTV | 0.003 | |
≤17.1 mL | ||
>17.1 mL | 6.80 (1.91–24.26) | |
TLG-TLR | 0.003 | |
≤70.3 | ||
>70.3 | 7.05 (1.97–25.17) | |
CV | 0.007 | |
≤29.8% | ||
>29.8% | 8.31 (1.76–39.20) | |
Multivariate analysis including overall stage, lymphovascular invasion, and SUVmax-TLR (PFS model 1) | ||
Overall stage (I–II vs. III) | 4.74 (1.20–18.68) | 0.03 |
Lymphovascular invasion (negative vs. positive) | 6.30 (1.58–25.18) | 0.009 |
SUVmax-TLR (≤7.1 vs. >7.1) | 4.43 (1.16–16.89) | 0.03 |
Multivariate analysis including overall stage, lymphovascular invasion, and MTV (PFS model 2) | ||
Overall stage (I–II vs. III) | 4.05 (0.98–16.75) | 0.054 |
Lymphovascular invasion (negative vs. positive) | 6.87 (1.73–27.28) | 0.006 |
MTV (≤17.1 vs. >17.1 mL) | 5.29 (1.31–21.45) | 0.02 |
Multivariate analysis including overall stage, lymphovascular invasion, and TLG-TLR (PFS model 3) | ||
Overall stage (I–II vs. III) | 4.74 (1.20–18.68) | 0.03 |
Lymphovascular invasion (negative vs. positive) | 6.30 (1.58–25.18) | 0.009 |
TLG-TLR (≤70.3 vs. >70.3) | 4.43 (1.16–16.89) | 0.03 |
Multivariate analysis including overall stage, lymphovascular invasion, and CV (PFS model 4) | ||
Overall stage (I–II vs. III) | 6.74 (1.69–26.88) | 0.007 |
Lymphovascular invasion (negative vs. positive) | 5.68 (1.37–23.59) | 0.02 |
CV (≤29.8 vs. >29.8%) | 6.40 (1.33–30.79) | 0.02 |
Characteristic | Hazard Ratio (95% CI) | p * |
---|---|---|
Univariate Analysis | ||
Age | 0.10 | |
≤57 years | ||
>57 years | 6.05 (0.73–50.25) | |
Sex | NR | |
Male | ||
Female | NR | |
ECOG | 0.21 | |
0 | ||
1 | 3.89 (0.47–32.31) | |
Smoking history | 0.55 | |
Never or ≤10 pack-years | ||
>10 pack-years | 1.58 (0.35–7.07) | |
Overall stage | 0.03 | |
I–II | ||
III | 5.34 (1.19–23.94) | |
Surgical approach | 0.22 | |
Open | ||
Robotic | 0.36 (0.07–1.83) | |
Resection margin | 0.16 | |
Negative | ||
Positive | 2.95 (0.66–13.20) | |
Extracapsular spread | 0.15 | |
Negative | ||
Positive | 4.68 (0.56–38.85) | |
Lymphovascular invasion | 0.04 | |
Negative | ||
Positive | 5.76 (1.12–29.70) | |
Perineural invasion | 0.28 | |
Negative | ||
Positive | 2.49 (0.48–12.86) | |
Adjuvant therapy | 0.15 | |
Radiotherapy | ||
Chemoradiotherapy | 0.33 (0.07–1.49) | |
Chemotherapy | 0.42 | |
Yes | 0.51 (0.10–2.62) | |
No | ||
SUVmax-TLR | 0.07 | |
≤5.3 | ||
>5.3 | 7.33 (0.88–60.90) | |
MTV | 0.07 | |
≤15.9 mL | ||
>15.9 mL | 4.08 (0.91–18.26) | |
TLG-TLR | 0.24 | |
≤9.1 | ||
>9.1 | 3.61 (0.43–30.00) | |
CV | 0.02 | |
≤29.8% | ||
>29.8% | 11.79 (1.42–98.02) | |
Multivariate analysis including overall stage, lymphovascular invasion, and CV | ||
Overall stage (I–II vs. III) | 4.93 (1.02–23.83) | 0.047 |
Lymphovascular invasion (negative vs. positive) | 4.55 (0.85–24.33) | 0.08 |
CV (≤29.8 vs. >29.8%) | 8.18 (0.96–69.95) | 0.06 |
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Cho, H.; Kim, S.; Jo, K.; Jeong, Y.H.; Kang, W.J. Tumor Glucose Metabolism and Its Heterogeneity on F-18 FDG PET/CT Provide Better Prognostication in Nonmetastatic Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma. Cancers 2021, 13, 5538. https://doi.org/10.3390/cancers13215538
Cho H, Kim S, Jo K, Jeong YH, Kang WJ. Tumor Glucose Metabolism and Its Heterogeneity on F-18 FDG PET/CT Provide Better Prognostication in Nonmetastatic Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma. Cancers. 2021; 13(21):5538. https://doi.org/10.3390/cancers13215538
Chicago/Turabian StyleCho, Hojin, Soyoung Kim, Kwanhyeong Jo, Yong Hyu Jeong, and Won Jun Kang. 2021. "Tumor Glucose Metabolism and Its Heterogeneity on F-18 FDG PET/CT Provide Better Prognostication in Nonmetastatic Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma" Cancers 13, no. 21: 5538. https://doi.org/10.3390/cancers13215538