Abstract
BackgroundIn this study, PET heterogeneity was combined with functional MRI techniques to refine the prediction of prognosis in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC).MethodsA total of 124 patients with primary advanced OHSCC who underwent pretreatment 18F-FDG PET/CT, dynamic contrast-enhanced MR imaging (DCE-MRI), and diffusion-weighted MR imaging (DWI) were enrolled. Conventional and heterogeneity parameters from 18F-FDG PET as well as perfusion parameters from DCE-MRI and diffusion parameter from DWI of primary tumors were analyzed in relation to recurrence-free survival (RFS) and overall survival (OS).ResultsMultivariate analysis identified hypopharyngeal tumors (P = 0.038), alcohol drinking (P = 0.006), Ktrans ≤ 0.5512 (P = 0.017), and Kep ≤ 0.8872 (P = 0.005) as adverse prognostic factors for RFS. Smoking (p = 0.009), Ktrans ≤ 0.5512 (P = 0.0002), Kep ≤ 0.8872 (P = 0.004), and the PET heterogeneity parameter uniformity ≤ 0.00381 (P = 0.028) were independent predictors of poor OS. The combination of PET uniformity with DCE-MRI parameters and smoking allowed distinguishing four prognostic groups, with 3-year OS rates of 100%, 76.6%, 57.4%, and 7.1%, respectively (P < 0.0001). This prognostic system appeared superior to both the TNM staging system (P = 0.186) and the combination of conventional PET parameters with DCE-MRI (P = 0.004).ConclusionsMultiparametric imaging based on PET heterogeneity and DCE-MRI parameters combined with clinical risk factors is superior to the concomitant use of functional MRI coupled with conventional PET parameters. This approach may improve the prognostic stratification of OHSCC patients.
Highlights
Head and neck malignancies are a heterogeneous group of cancers arising within the upper aerodigestive tract that collectively represent the seventh most commonly diagnosed cancer worldwide [1]
The results of the current study demonstrate that imaging heterogeneity on 18F-FDG PET scans is associated with survival rates in patients with primary or hypopharyngeal squamous cell carcinoma (OHSCC)
We show that its combination with dynamic contrast-enhanced MR imaging (DCE-MRI) parameters may allow a better prognostic stratification compared with the traditional TNM staging system or even the combination of the conventional PET parameters and functional MRI measures
Summary
Head and neck malignancies are a heterogeneous group of cancers arising within the upper aerodigestive tract that collectively represent the seventh most commonly diagnosed cancer worldwide [1]. Up to 26% of patients who achieve a clinical complete response after chemoradiotherapy still have evidence of residual regional lymph node metastases [3] In this scenario, there is an urgent need to improve prognostic stratification, with the ultimate goal of optimizing follow-up schedules, treatment planning, and clinical outcomes. Conclusions: Multiparametric imaging based on PET heterogeneity and DCE-MRI parameters combined with clinical risk factors is superior to the concomitant use of functional MRI coupled with conventional PET parameters. This approach may improve the prognostic stratification of OHSCC patients
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