Clinical utility of multimodality imaging with dynamic contrast-enhanced MRI, diffusion-weighted MRI, and 18F-FDG PET/CT for the prediction of neck control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation.
Clinical utility of multimodality imaging with dynamic contrast-enhanced MRI, diffusion-weighted MRI, and 18F-FDG PET/CT for the prediction of neck control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation.
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DOI：
10.1371/journal.pone.0115933
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Wang JJ
中科院分区：
文献类型：
--
作者：
Ng SH;Lin CY;Chan SC;Lin YC;Yen TC;Liao CT;Chang JT;Ko SF;Wang HM;Chang CJ;Wang JJ
治疗前成像技术在预测接受放化疗的口咽或下咽鳞状细胞癌（OHSCC）患者的颈部控制方面的临床用途尚不清楚。在这项前瞻性研究中，我们研究了治疗前动态对比增强灌注磁共振成像 (DCE-PWI)、弥散加权磁共振成像 (DWI) 和 [18F] 氟脱氧葡萄糖-正电子发射断层扫描 (18F-FDG PET)/CT 衍生成像标记物在预测接受放化疗的 OHSCC 患者颈部控制方面的作用。 2010 年 8 月至 2012 年 7 月期间计划接受放化疗的未经治疗的 OHSCC 患者符合本研究的资格。检查与颈部控制相关的转移性颈部淋巴结的临床变量和以下成像参数：转移常数、血浆体积和 DCE-PWI 上的细胞外血管外空间 (Ve) 体积； DWI 表观扩散系数 (ADC)； 18F-FDG PET/CT 上的最大标准化摄取值、代谢肿瘤体积和总病灶糖酵解。有 69 例患者（37 例口咽 SCC，32 例下咽 SCC）接受了成功的预处理 DCE-PWI 和 DWI，可供分析。中位随访 31 个月后，25 名参与者 (36.2%) 出现颈部衰竭。多变量分析确定血红蛋白水平<14.3 g/dL (P = 0.019)、Ve <0.23 (P = 0.040)和ADC>1.14×10−3 mm2/s (P = 0.003)作为3年颈部控制的独立预后因素。通过总结颈部控制的三个重要预测因素，制定了预后评分系统。得分为 2-3 的患者的颈部控制和总体生存率明显低于得分为 0-1 的患者。我们得出结论，血红蛋白水平、Ve 和 ADC 是放化疗治疗 OHSCC 颈部控制的独立治疗前预后因素。它们的组合可能会识别出发生颈部衰竭高风险的患者亚组。
The clinical usefulness of pretreatment imaging techniques for predicting neck control in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) treated with chemoradiation remains unclear. In this prospective study, we investigated the role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI), diffusion-weighted MR imaging (DWI), and [18F]fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT derived imaging markers for the prediction of neck control in OHSCC patients treated with chemoradiation. Patients with untreated OHSCC scheduled for chemoradiation between August, 2010 and July, 2012 were eligible for the study. Clinical variables and the following imaging parameters of metastatic neck lymph nodes were examined in relation to neck control: transfer constant, volume of blood plasma, and volume of extracellular extravascular space (Ve) on DCE-PWI; apparent diffusion coefficient (ADC) on DWI; maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis on 18F-FDG PET/CT. There were 69 patients (37 with oropharynx SCC and 32 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 31 months, 25 (36.2%) participants had neck failure. Multivariate analysis identified hemoglobin level <14.3 g/dL (P = 0.019), Ve <0.23 (P = 0.040), and ADC >1.14×10−3 mm2/s (P = 0.003) as independent prognostic factors for 3-year neck control. A prognostic scoring system was formulated by summing up the three significant predictors of neck control. Patients with scores of 2–3 had significantly poorer neck control and overall survival rates than patients with scores of 0–1. We conclude that hemoglobin levels, Ve, and ADC are independent pretreatment prognostic factors for neck control in OHSCC treated with chemoradiation. Their combination may identify a subgroup of patients at high risk of developing neck failure.
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Clinical cancer research : an official journal of the American Association for Cancer Research
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