Reflecting on the Utility of Standardized Uptake Values on F-FDG PET in Nasopharyngeal Carcinoma

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2022 May 5

PMID 35513804

Authors

Xiufang Qiu

Haixia Wu

Ting Xu

Shihan Xie

Ziqing You

YiXin Hu

Yinghong Zheng

Zewei Liang

Chaoxiong Huang

Li Yi

Li Li

Jing Liu

Zhaodong Fei

Chuanben Chen

Affiliations

Soon will be listed here.

Abstract

Background: To rethink the clinical significance of standardized uptake values (SUVs) of nasopharyngeal carcinoma (NPC) on F-fluorodeoxyglucose (F-FDG) positron-emission tomography (PET).

Methods: We retrospectively reviewed 369 NPC patients who underwent pretreatment F-FDG PET. The predictive value of the SUVmax of the primary tumor (SUVmax-t) and regional lymph nodes (SUVmax-n) was evaluated using probability density functions. Receiver operating characteristic curves were used to determine optimal cutoffs for the SUVmax-n/SUVmax-t ratio (NTR). Kaplan-Meier and Cox regression analyses were used to assess survival.

Results: The optimal SUVmax-t and SUVmax-n cutoffs were 7.5 and 6.9, respectively. High SUVmax-t and SUVmax-n were related to local and regional recurrence, respectively. Patients with low SUVmax had better 3-year overall survival (OS). To avoid cross-sensitization of cutoff points, we stratified patients with high SUVmax into the low and high NTR groups. The 3-year distant metastasis-free survival (DMFS; 92.3 vs. 80.6%, P = 0.009), progression-free survival (PFS; 84.0 vs. 67.7%, P = 0.011), and OS (95.9 vs. 89.2%, P = 0.002) significantly differed between the high vs. low NTR groups for patients with high SUVmax. Multivariable analysis showed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR]: 2.037, 95% CI: 1.039-3.992, P = 0.038), PFS (HR: 1.636, 95% CI: 1.021-2.621, P = 0.041), and OS (HR: 2.543, 95% CI: 1.214-5.325, P = 0.013).

Conclusion: High SUVmax was associated with NPC recurrence. NTR is a potential prognosticator for DMFS, suggesting that heterogeneity in the pretreatment F-FDG uptake between the primary tumor and lymph nodes is associated with high invasion and metastatic potential.

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References

Lee N, Zhang Q, Pfister D, Kim J, Garden A, Mechalakos J . Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. Lancet Oncol. 2011; 13(2):172-80. PMC: 4985181. DOI: 10.1016/S1470-2045(11)70303-5. View

You R, Hua Y, Liu Y, Yang Q, Zhang Y, Li J . Concurrent Chemoradiotherapy with or without Anti-EGFR-Targeted Treatment for Stage II-IVb Nasopharyngeal Carcinoma: Retrospective Analysis with a Large Cohort and Long Follow-up. Theranostics. 2017; 7(8):2314-2324. PMC: 5505063. DOI: 10.7150/thno.19710. View

Fei Z, Chen C, Huang Y, Qiu X, Li Y, Li L . Metabolic tumor volume and conformal radiotherapy based on prognostic PET/CT for treatment of nasopharyngeal carcinoma. Medicine (Baltimore). 2019; 98(28):e16327. PMC: 6641822. DOI: 10.1097/MD.0000000000016327. View

Chen Y, Chan A, Le Q, Blanchard P, Sun Y, Ma J . Nasopharyngeal carcinoma. Lancet. 2019; 394(10192):64-80. DOI: 10.1016/S0140-6736(19)30956-0. View

Ma G, Gu B, Hu J, Kong L, Zhang J, Li Z . Pretreatment F-FDG uptake heterogeneity can predict treatment outcome of carbon ion radiotherapy in patients with locally recurrent nasopharyngeal carcinoma. Ann Nucl Med. 2021; 35(7):834-842. DOI: 10.1007/s12149-021-01621-8. View

Liu L, Tang L, Chen Q, Zhang L, Guo S, Guo L . The Prognostic Value of Plasma Epstein-Barr Viral DNA and Tumor Response to Neoadjuvant Chemotherapy in Advanced-Stage Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys. 2015; 93(4):862-9. DOI: 10.1016/j.ijrobp.2015.08.003. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Yang Z, Shi Q, Zhang Y, Pan H, Yao Z, Hu S . Pretreatment (18)F-FDG uptake heterogeneity can predict survival in patients with locally advanced nasopharyngeal carcinoma--a retrospective study. Radiat Oncol. 2015; 10:4. PMC: 4311496. DOI: 10.1186/s13014-014-0268-5. View

Chang K, Tsang N, Liao C, Hsu C, Chung M, Lo C . Prognostic significance of 18F-FDG PET parameters and plasma Epstein-Barr virus DNA load in patients with nasopharyngeal carcinoma. J Nucl Med. 2012; 53(1):21-8. DOI: 10.2967/jnumed.111.090696. View

10.

Chung H, Cheon G, Kim J, Park N, Song Y . Prognostic value of lymph node-to-primary tumor standardized uptake value ratio in endometrioid endometrial carcinoma. Eur J Nucl Med Mol Imaging. 2017; 45(1):47-55. DOI: 10.1007/s00259-017-3805-2. View

11.

Lee S, Nam S, Im K, Kim J, Choi E, Ahn S . Prediction of prognosis using standardized uptake value of 2-[(18)F] fluoro-2-deoxy-d-glucose positron emission tomography for nasopharyngeal carcinomas. Radiother Oncol. 2008; 87(2):211-6. DOI: 10.1016/j.radonc.2008.01.009. View

12.

Chan S, Yeh C, Chang J, Chang K, Wang J, Ng S . Combing MRI Perfusion and F-FDG PET/CT Metabolic Biomarkers Helps Predict Survival in Advanced Nasopharyngeal Carcinoma: A Prospective Multimodal Imaging Study. Cancers (Basel). 2021; 13(7). PMC: 8036946. DOI: 10.3390/cancers13071550. View

13.

Fei Z, Xu T, Li M, Chen T, Li L, Qiu X . Effectiveness and cost-effectiveness analysis of nimotuzumab for the radiotherapy of locoregionally advanced nasopharyngeal carcinoma. Radiat Oncol. 2020; 15(1):230. PMC: 7530954. DOI: 10.1186/s13014-020-01674-5. View

14.

Lee S, Kay C, Kim Y, Son S, Kim M, Lee S . Prognostic value of nodal SUVmax of 18F-FDG PET/CT in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Radiat Oncol J. 2017; 35(4):306-316. PMC: 5769881. DOI: 10.3857/roj.2017.00115. View

15.

Wong K, Hui E, Lo K, Lam W, Johnson D, Li L . Nasopharyngeal carcinoma: an evolving paradigm. Nat Rev Clin Oncol. 2021; 18(11):679-695. DOI: 10.1038/s41571-021-00524-x. View

16.

Jeong Y, Baek S, Park J, Joo J, Kim J, Lee S . Lymph node standardized uptake values at pre-treatment F-fluorodeoxyglucose positron emission tomography as a valuable prognostic factor for distant metastasis in nasopharyngeal carcinoma. Br J Radiol. 2016; 90(1071):20160239. PMC: 5601521. DOI: 10.1259/bjr.20160239. View

17.

Cho H, Kim S, Kim H, Koh Y, Kim S, Choi E . Lymph Node With the Highest FDG Uptake Predicts Distant Metastasis-Free Survival in Patients With Locally Advanced Nasopharyngeal Carcinoma. Clin Nucl Med. 2018; 43(7):e220-e225. DOI: 10.1097/RLU.0000000000002145. View

18.

Hung T, Fan K, Kang C, Huang S, Lin C, Ho A . Lymph node-to-primary tumor standardized uptake value ratio on PET predicts distant metastasis in nasopharyngeal carcinoma. Oral Oncol. 2020; 110:104756. DOI: 10.1016/j.oraloncology.2020.104756. View

19.

Chan W, Kwong D, Yeung D, Huang B, Khong P . Prognostic impact of standardized uptake value of F-18 FDG PET/CT in nasopharyngeal carcinoma. Clin Nucl Med. 2011; 36(11):1007-11. DOI: 10.1097/RLU.0b013e31821a29a4. View

20.

Xia W, Liang H, Lv X, Wang L, Qian C, Ye Y . Combining cetuximab with chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma: A propensity score analysis. Oral Oncol. 2017; 67:167-174. DOI: 10.1016/j.oraloncology.2017.02.026. View