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Prognostic value of primary gross tumor volume and standardized uptake value of (18)F-FDG in PET/CT for distant metastasis in locoregionally advanced nasopharyngeal carcinoma.

Abstract Distant metastasis has become the predominant model of treatment failures in patients with locoregionally advanced nasopharyngeal carcinoma. Effort should therefore be made to stratify locoregionally advanced nasopharyngeal carcinoma patients into different groups based on the risk of metastasis to improve prognosis and tailor individualized treatments. This study aims to assess the value of primary gross tumor volume and the maximum standardized uptake value for predicting distant metastasis-free survival of patients with locoregionally advanced nasopharyngeal carcinoma. A total of 294 locoregionally advanced nasopharyngeal carcinoma patients who were identified from prospectively maintained database and underwent fluor-18-fluorodeoxyglucose positron emission tomography/computed tomography imaging before treatment were included. The maximum standardized uptake value was recorded for the primary tumor (SUVmax-P) and neck lymph nodes (SUVmax-N). Computed tomography-derived primary gross tumor volume was measured using the summation-of-area technique. At 5 years, the distant metastasis-free survival rate was 83.7%. The cut-off of the SUVmax-P, SUVmax-N, and primary gross tumor volume for distant metastasis-free survival was 8.95, 5.75, and 31.3 mL, respectively, by receiver operating characteristic curve. In univariate analysis, only SUVmax-N (hazard ratio: 7.01; 95% confidence interval: 1.70-28.87; p < 0.01) and clinical stage (hazard ratio: 3.03; 95% confidence interval: 1.67-5.47; p = 0.007) were confirmed as independent predictors of distant metastasis-free survival. A prognostic model was derived by SUVmax-N and clinical stage: low risk (SUVmax-N < 5.75 regardless of clinical stage), medium risk (stage III and SUVmax-N ≥ 5.75), and high risk (stage IV and SUVmax-N ≥ 5.75). Multivariate analysis revealed that SUVmax-N and the prognostic model remained independent prognostic factors for distant metastasis-free survival (p = 0.023 and p < 0.001, respectively), but the clinical stage became insignificant (p = 0.133). Furthermore, the adjusted hazard ratios for the prognostic model were higher than SUVmax-N (hazard ratio = 6.27 vs 5.21, respectively). In summary, compared with SUVmax-P, SUVmax-N may be a better predictor of distant metastasis-free survival for patients with locoregionally advanced nasopharyngeal carcinoma. Combining SUVmax-N with clinical stage gives a more precise picture in predicting distant metastasis.
PMID
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Authors

Mayor MeshTerms
Keywords

Nasopharyngeal carcinoma

distant metastasis

locoregionally advanced

maximum standardized uptake value

tumor volume

Journal Title tumour biology : the journal of the international society for oncodevelopmental biology and medicine
Publication Year Start




PMID- 28671052
OWN - NLM
STAT- In-Process
DA  - 20170703
LR  - 20170703
IS  - 1423-0380 (Electronic)
IS  - 1010-4283 (Linking)
VI  - 39
IP  - 7
DP  - 2017 Jul
TI  - Prognostic value of primary gross tumor volume and standardized uptake value of
      18F-FDG in PET/CT for distant metastasis in locoregionally advanced
      nasopharyngeal carcinoma.
PG  - 1010428317717843
LID - 10.1177/1010428317717843 [doi]
AB  - Distant metastasis has become the predominant model of treatment failures in
      patients with locoregionally advanced nasopharyngeal carcinoma. Effort should
      therefore be made to stratify locoregionally advanced nasopharyngeal carcinoma
      patients into different groups based on the risk of metastasis to improve
      prognosis and tailor individualized treatments. This study aims to assess the
      value of primary gross tumor volume and the maximum standardized uptake value for
      predicting distant metastasis-free survival of patients with locoregionally
      advanced nasopharyngeal carcinoma. A total of 294 locoregionally advanced
      nasopharyngeal carcinoma patients who were identified from prospectively
      maintained database and underwent fluor-18-fluorodeoxyglucose positron emission
      tomography/computed tomography imaging before treatment were included. The
      maximum standardized uptake value was recorded for the primary tumor (SUVmax-P)
      and neck lymph nodes (SUVmax-N). Computed tomography-derived primary gross tumor 
      volume was measured using the summation-of-area technique. At 5 years, the
      distant metastasis-free survival rate was 83.7%. The cut-off of the SUVmax-P,
      SUVmax-N, and primary gross tumor volume for distant metastasis-free survival was
      8.95, 5.75, and 31.3 mL, respectively, by receiver operating characteristic
      curve. In univariate analysis, only SUVmax-N (hazard ratio: 7.01; 95% confidence 
      interval: 1.70-28.87; p &lt; 0.01) and clinical stage (hazard ratio: 3.03; 95%
      confidence interval: 1.67-5.47; p = 0.007) were confirmed as independent
      predictors of distant metastasis-free survival. A prognostic model was derived by
      SUVmax-N and clinical stage: low risk (SUVmax-N &lt; 5.75 regardless of clinical
      stage), medium risk (stage III and SUVmax-N &gt;/= 5.75), and high risk (stage IV
      and SUVmax-N &gt;/= 5.75). Multivariate analysis revealed that SUVmax-N and the
      prognostic model remained independent prognostic factors for distant
      metastasis-free survival (p = 0.023 and p &lt; 0.001, respectively), but the
      clinical stage became insignificant (p = 0.133). Furthermore, the adjusted hazard
      ratios for the prognostic model were higher than SUVmax-N (hazard ratio = 6.27 vs
      5.21, respectively). In summary, compared with SUVmax-P, SUVmax-N may be a better
      predictor of distant metastasis-free survival for patients with locoregionally
      advanced nasopharyngeal carcinoma. Combining SUVmax-N with clinical stage gives a
      more precise picture in predicting distant metastasis.
FAU - Jin, Ya-Nan
AU  - Jin YN
AD  - 1 Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in
      South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen
      University Cancer Center, Guangzhou, P.R. China.
FAU - Yao, Ji-Jin
AU  - Yao JJ
AD  - 2 Department of Radiation Oncology, State Key Laboratory of Oncology in South
      China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen
      University Cancer Center, Guangzhou, P.R. China.
AD  - 3 Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen 
      University, Zhuhai, P.R. China.
FAU - Wang, Si-Yang
AU  - Wang SY
AD  - 3 Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen 
      University, Zhuhai, P.R. China.
FAU - Zhang, Wang-Jian
AU  - Zhang WJ
AD  - 4 Department of Medical Statistics and Epidemiology &amp; Health Information Research
      Center &amp; Guangdong Key Laboratory of Medicine, School of Public Health, Sun
      Yat-sen University, Guangzhou, P.R. China.
FAU - Zhou, Guan-Qun
AU  - Zhou GQ
AD  - 2 Department of Radiation Oncology, State Key Laboratory of Oncology in South
      China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen
      University Cancer Center, Guangzhou, P.R. China.
FAU - Zhang, Fan
AU  - Zhang F
AD  - 3 Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen 
      University, Zhuhai, P.R. China.
FAU - Cheng, Zhi-Bin
AU  - Cheng ZB
AD  - 3 Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen 
      University, Zhuhai, P.R. China.
FAU - Ma, Jun
AU  - Ma J
AD  - 2 Department of Radiation Oncology, State Key Laboratory of Oncology in South
      China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen
      University Cancer Center, Guangzhou, P.R. China.
FAU - Mo, Hao-Yuan
AU  - Mo HY
AD  - 1 Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in
      South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen
      University Cancer Center, Guangzhou, P.R. China.
FAU - Sun, Ying
AU  - Sun Y
AD  - 2 Department of Radiation Oncology, State Key Laboratory of Oncology in South
      China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen
      University Cancer Center, Guangzhou, P.R. China.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Tumour Biol
JT  - Tumour biology : the journal of the International Society for Oncodevelopmental
      Biology and Medicine
JID - 8409922
OTO - NOTNLM
OT  - Nasopharyngeal carcinoma
OT  - distant metastasis
OT  - locoregionally advanced
OT  - maximum standardized uptake value
OT  - tumor volume
EDAT- 2017/07/04 06:00
MHDA- 2017/07/04 06:00
CRDT- 2017/07/04 06:00
AID - 10.1177/1010428317717843 [doi]
PST - ppublish
SO  - Tumour Biol. 2017 Jul;39(7):1010428317717843. doi: 10.1177/1010428317717843.