Abstract
BackgroundIntratumoral heterogeneity has an enormous effect on patient treatment and outcome. The purpose of the current study was to establish and validate a nomogram with intratumoral heterogeneity derived from 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prognosis of 5-Year progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC).MethodsA total of 171 NPC patients who underwent pretreatment 18F-FDG PET/CT were retrospectively enrolled. Data was randomly divided into training cohort (n = 101) and validation cohort (n = 70). The clinicopathologic parameters and the following PET parameters were analyzed: maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI, SUVmax/SUVmean) for primary tumor and maximal neck lymph node. Cox analyses were performed on PFS in the training cohort. A prognostic nomogram based on this model was developed and validated.ResultsFor the primary tumor, MTV-2.5, TLG-2.5, MTV-70%, and TLG-70% were significantly correlated with PFS. For the maximal neck lymph node, short diameter and HI were significantly correlated with PFS. Among the clinicopathologic parameters, M stage was a significant prognostic factor for recurrence. In multivariate analysis, M stage (P = 0.006), TLG-T-70% (P = 0.002), and HI-N (P = 0.018) were independent predictors. Based on this prognostic model, a nomogram was generated. The C-index of this model was 0.74 (95% CI: 0.63–0.85). For the cross validation, the C-index for the model was 0.73 (95% CI: 0.62–0.83) with the validation cohort. Patients with a risk score of ≥111 had poorer survival outcomes than those with a risk score of 0–76 and 77–110.ConclusionsIntratumoral heterogeneity derived from 18F-FDG PET/CT could predict long-term outcome in patients with primary NPC. A combination of PET parameters and the TNM stage enables better stratification of patients into subgroups with different PFS rates.
Highlights
Intratumoral heterogeneity has an enormous effect on patient treatment and outcome
Intratumoral heterogeneity derived from 18F-from 18Ffluorodeoxyglucose (FDG) PET/Positron emission tomography/computed tomography (CT) could predict long-term outcome in patients with primary nasopharyngeal carcinoma (NPC)
For the maximal neck lymph node, short diameter and heterogeneity index (HI) were significantly correlated with progression-free survival (PFS), with a Cindex of 0.63 and 0.66, respectively
Summary
Intratumoral heterogeneity has an enormous effect on patient treatment and outcome. The purpose of the current study was to establish and validate a nomogram with intratumoral heterogeneity derived from 18Ffluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prognosis of 5-Year progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC). Methods: A total of 171 NPC patients who underwent pretreatment 18F-FDG PET/CT were retrospectively enrolled. The clinicopathologic parameters and the following PET parameters were analyzed: maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI, SUVmax/SUVmean) for primary tumor and maximal neck lymph node. Due to the anatomic location and high radiosensitivity, radiotherapy (RT) is the primary and only curative treatment for nasopharyngeal carcinoma. The long-term prognosis remains relatively poor as the current therapeutic regimens are mainly depended on TNM stage [7,8,9]
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