Pretreatment Photopenia on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scans Predicts Poor Prognosis in Nasopharyngeal Cancer Patients Undergoing Concurrent Chemoradiotherapy
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Objectives. To investigate the influence of pretreatment primary tumor or nodal photopenia (PP) on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT), an indicator of tumor ischemia, on survival results of nasopharyngeal cancers (NPCs) treated with concurrent chemoradiotherapy (C-CRT). Methods. The pre-C-CRT FDG PET-CT scans of 104 patients with NPC (cT1-4 N0-3 M0) were retrospectively examined to determine the presence of PP (PP+). Our primary endpoint was the influence of PP+ on overall survival (OS), while the progression-free survival (PFS) and locoregional PFS (LRPFS) constituted the secondary endpoints. Results. The PP+ was detected in 29 (27.9%): nine (8.7%), seven (6.7%), and 13 (12.5%) in the primary tumor alone, primary tumor plus neck nodes, and neck nodes alone, respectively. Because the PP+ cases were small by count per location, all comparative analyses were performed according to overall PP+/ PP– status instead of per detected site. At a median follow-up of 67.8 months (range, 9 to 130 months), the median survival times were not reached (NR) for the entire population, while 5-year OS, LRPFS, and PFS rates were 73.3%, 68.2%, and 63.4%, respectively. Comparatively the PP+ patients exhibited significantly poorer median OS (49.8 months vs. NR, P<0.001), LRPFS (40.7 months vs. NR, P=0.001), and PFS (31.8 months vs. NR, P=0.002) durations than their PP– counterparts. Furthermore, the PP+ retained its independent prognostic significance in multivariate analysis (P<0.001). Conclusion. Present results uncovered the pre-C-CRT PP as an independent predictor of poor prognosis for NPC patients, which underscore the requirement for the fortification of the local and systemic treatments in hypoxic NPCs.
Abstract
Objectives. To investigate the influence of pretreatment primary tumor or nodal photopenia (PP) on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT), an indicator of tumor ischemia, on survival results of nasopharyngeal cancers (NPCs) treated with concurrent chemoradiotherapy (C-CRT). Methods. The pre-C-CRT FDG PET-CT scans of 104 patients with NPC (cT1-4 N0-3 M0) were retrospectively examined to determine the presence of PP (PP+). Our primary endpoint was the influence of PP+ on overall survival (OS), while the progression-free survival (PFS) and locoregional PFS (LRPFS) constituted the secondary endpoints. Results. The PP+ was detected in 29 (27.9%): nine (8.7%), seven (6.7%), and 13 (12.5%) in the primary tumor alone, primary tumor plus neck nodes, and neck nodes alone, respectively. Because the PP+ cases were small by count per location, all comparative analyses were performed according to overall PP+/ PP– status instead of per detected site. At a median follow-up of 67.8 months (range, 9 to 130 months), the median survival times were not reached (NR) for the entire population, while 5-year OS, LRPFS, and PFS rates were 73.3%, 68.2%, and 63.4%, respectively. Comparatively the PP+ patients exhibited significantly poorer median OS (49.8 months vs. NR, P<0.001), LRPFS (40.7 months vs. NR, P=0.001), and PFS (31.8 months vs. NR, P=0.002) durations than their PP– counterparts. Furthermore, the PP+ retained its independent prognostic significance in multivariate analysis (P<0.001). Conclusion. Present results uncovered the pre-C-CRT PP as an independent predictor of poor prognosis for NPC patients, which underscore the requirement for the fortification of the local and systemic treatments in hypoxic NPCs.
참고문헌 (28)
- Lin JC, "Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma : positive effect on overall and progression-free survival", J Clin Oncol, 21(4), pp.631~637 (2003)
- Chan AT, "Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma : progression-free survival analysis of a phase III randomized trial", J Clin Oncol, 20(8), pp.2038~2044 (2002)
- Lydiatt WM, "Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual", CA Cancer J Clin, 67(2), pp.122~137 (2017)
- Li J, "Prognostic nomogram for patients with nasopharyngeal carcinoma incorporating hematological biomarkers and clinical characteristics", Int J Biol Sci, 14(5), pp.549~556 (2018)
- Topkan E, "Baseline hemoglobin <11.0 g", dL has stronger prognostic value than anemia status in nasopharynx cancers treated with chemoradiotherapy, 2019, pp.34(2), 139~147
- -fluorodeoxyglucose positron emission tomography, "computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer", Clin Cancer Res, 15(18), pp.5861~5868 (2009)
- Paidpally V, "FDG volumetric parameters and survival outcomes after definitive chemoradiotherapy in patients with recurrent head and neck squamous cell carcinoma", AJR Am J Roentgenol, 203(2), pp.W139~W145 (2014)
- Nakamura K, "Measurement of SUVmax plus ADCmin of the primary tumour is a predictor of prognosis in patients with cervical cancer", Eur J Nucl Med Mol Imaging, 39(2), pp.283~290 (2012)
- Castelli J, "Metabolic tumor volume and total lesion glycolysis in oropharyngeal cancer treated with definitive radiotherapy: which threshold is the best predictor of local control?", Clin Nucl Med, 42(6), pp.e281~e285 (2017)
- Choi WR, "Metabolic tumor volume and total lesion glycolysis predict tumor progression and survival after salvage surgery for recurrent oral cavity squamous cell carcinoma", Head Neck, 41(6), pp.1846~1853 (2019)
- Ashley Cox R, "Survival and central photopenia detected by fluorine-18 fluoro-deoxy-glucose positron emission tomography(FDG-PET)in patients with locoregional non-small cell lung cancer treated with radiotherapy", Radiother Oncol, 124(1), pp.25~30 (2017)
- Xie W, "Prognostic value of hypoxia-inducible factor-1 alpha in nasopharyngeal carcinoma: a meta-analysis", Int J Biol Markers, 33(4), pp.447~454 (2018)
- Yip C, "Clinical significance of hypoxia in nasopharyngeal carcinoma with a focus on existing and novel hypoxia molecular imaging", Chin Clin Oncol, 5(2), pp.24~ (2016)
- Hong B, "Targeting tumor hypoxia in nasopharyngeal carcinoma", Head Neck, 35(1), pp.133~145 (2013)
- Bredell MG, "Current relevance of hypoxia in head and neck cancer", Oncotarget, 7(31), pp.50781~50804 (2016)
- Al-Zoughbi W, "Tumor macroenvironment and metabolism", Semin Oncol, 41(2), pp.281~295 (2014)
- Horsman MR, "Imaging hypoxia to improve radiotherapy outcome", Nat Rev Clin Oncol, 9(12), pp.674~687 (2012)
- Lin YC, "Risk stratification of metastatic neck nodes by CT and PET in patients with head and neck cancer receiving definitive radiotherapy", J Nucl Med, 56(2), pp.183~189 (2015)
- Koukourakis MI, "Endogenous markers of two separate hypoxia response pathways(hypoxia inducible factor 2 alpha and carbonic anhydrase 9)are associated with radiotherapy failure in head and neck cancer patients recruited in the CHART randomized trial", J Clin Oncol, 24(5), pp.727~735 (2006)
- Rademakers SE, "Metabolic markers in relation to hypoxia; staining patterns and colocalization of pimonidazole, HIF-1α, CAIX, LDH-5, GLUT-1, MCT1 and MCT4", BMC Cancer, 11, pp.167~ (2011)
- Lan M, "Prognostic value of cervical nodal necrosis in nasopharyngeal carcinoma : analysis of 1800 patients with positive cervical nodal metastasis at MR imaging", Radiology, 276(2), pp.536~544 (2015)
- Tang L, "Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma detected by magnetic resonance imaging : prognostic value and staging categories", Cancer, 113(2), pp.347~354 (2008)
- Zhang LL, "Influence of cervical node necrosis of different grades on the prognosis of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy", J Cancer, 8(6), pp.959~966 (2017)
- Nordsmark M, "Tumor hypoxia is independent of hemoglobin and prognostic for loco-regional tumor control after primary radiotherapy in advanced head and neck cancer", Acta Oncol, 43(4), pp.396~403 (2004)
- Lee AW, "Evolution of treatment for nasopharyngeal cancer : success and setback in the intensity-modulated radiotherapy era", Radiother Oncol, 110(3), pp.377~384 (2014)
- Hong B, "Hypoxia-targeting by tirapazamine(TPZ)induces preferential growth inhibition of nasopharyngeal carcinoma cells with Chk1", 2 activation, 2011, pp.29(3), 401~410
- Erler JT, "Lysyl oxidase is essential for hypoxia-induced metastasis", Nature, 440(7088), pp.1222~1226 (2006)
- Xueguan L, "Hypoxia inducible factor-1 alpha and vascular endothelial growth factor expression are associated with a poor prognosis in patients with nasopharyngeal carcinoma receiving radiotherapy with carbogen and nicotinamide", Clin Oncol(R Coll Radiol), 20(8), pp.606~612 (2008)