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Abstract
Due to the heterogeneity of tumour mass segmentation methods and lack of consensus, our study evaluated the prognostic value of pretherapeutic positron emission tomography with fluorodeoxyglucose (FDG-PET) metabolic parameters using different segmentation methods in patients with localized anal squamous cell carcinoma (SCC). Eighty-one patients with FDG-PET before radiochemotherapy were retrospectively analyzed. Semiquantitative data were measured with three fixed thresholds (35%, 41% and 50% of Maximum Standardized Uptake Value (SUVmax)) and four segmentation methods based on iterative approaches (Black, Adaptive, Nestle and Fitting). Metabolic volumes of primary anal tumour (P-MTV) and total tumour load (T-MTV: P-MTV+ lymph node MTV) were calculated. The primary endpoint was event-free survival (EFS). Seven multivariate models were created to compare FDG-PET tumour volumes prognostic impact. For all segmentation thresholds, PET metabolic volume parameters were independent prognostic factor and T-MTV variable was consistently better associated with EFS than P-MTV. Patient’s sex was an independent variable and significantly correlated with EFS. With fixed threshold segmentation methods, 35% of SUVmax threshold seemed better correlated with EFS and the best cut-off for discrimination between a low and high risk of event occurrence was 40 cm3. Determination of T-MTV by FDG-PET using fixed threshold segmentation is useful for predicting EFS for primary anal SCC. If these data are confirmed in larger studies, FDG-PET could contribute to individualized patient therapies.
Highlights
Anal squamous cell carcinoma (SCC) is a rare tumour that accounts for only 1.5% of digestive cancers, but its incidence has increased in recent decades [1,2,3,4,5]
The node staging was modified in 34.6% of patients with a node upstaging in 29.6%: 63 patients with a node stage N0 or N1 by conventional imaging were up-staged in N2 for 11 of them (17.5%) and N3 for 7 (11%)
Of 35% of the SUVmax threshold and stratified on gender: (A) female population and (B) male. This retrospective study shows the prognostic value of total tumour metabolic volumes in the initial
Summary
Anal squamous cell carcinoma (SCC) is a rare tumour that accounts for only 1.5% of digestive cancers, but its incidence has increased in recent decades [1,2,3,4,5]. More than 90% of patients present with locoregional disease at diagnosis and the standard treatment are based on radiochemotherapy [6,7,8,9] This therapeutic approach for locally advanced anal SCC has led to a five-year overall survival (OS). Several teams have investigated the prognostic value of semiquantitative PET data during pretherapy, post-therapy and the metabolic response phases of this pathology [20,28,29,30,31,32,33,34] While these studies showed a prognostic value for the MTV (metabolic tumour volume) using pretherapeutic
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