A PET/CT-based strategy is a stronger predictor of survival than a standard imaging strategy in patients with head and neck squamous cell carcinoma

Max Rohde, Anne L Nielsen, Manan Pareek, Jørgen Johansen, Jens A Sørensen, Anabel Diaz, Mie K Nielsen, Janus M Christiansen, Jon T Asmussen, Nina Nguyen, Oke Gerke, Anders Thomassen, Abass Alavi, Poul Flemming Høilund-Carlsen, Christian Godballe

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Our purpose was to examine whether staging of head and neck squamous cell carcinoma (HNSCC) by upfront 18F-FDG PET/CT (i.e., on the day of biopsy and before the biopsy) discriminates survival better than the traditional imaging strategies based on chest x-ray plus head and neck MRI (CXR/MRI) or chest CT plus head and neck MRI (CCT/MRI). Methods: We performed a masked prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited from Odense University Hospital from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/ MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I and II), locally advanced (stages III and IVB), or metastatic (stage IVC). Discriminative ability for each imaging modality with respect to HNSCC staging were compared using Kaplan–Meier analysis, Cox proportional hazards regression with the Harrell C-index, and net reclassification improvement. Results: In total, 307 patients with histologically verified HNSCC were included. Use of PET/CT significantly altered the stratification of tumor stage when compared with either CXR/MRI or CCT/MRI (x 2, P, 0.001 for both). Cancer stages based on PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk on Kaplan–Meier analyses (P # 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/ CT (C-index, 0.712) than for CXR/MRI (C-index, 0.675; P 5 0.04) or CCT/MRI (C-index, 0.657; P 5 0.02). Finally, PET/CT was significantly associated with a positive net reclassification improvement when compared with CXR/MRI (0.184, P 5 0.03) but not CCT/MRI (0.094%, P 5 0.31). Conclusion: Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies.

OriginalsprogEngelsk
TidsskriftJournal of Nuclear Medicine
Vol/bind59
Udgave nummer4
Sider (fra-til)575-581
ISSN0161-5505
DOI
StatusUdgivet - 1. apr. 2018

Fingeraftryk

Neoplasms
Fluorodeoxyglucose F18
Cohort Studies
X-Rays
Prospective Studies

Citer dette

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title = "A PET/CT-based strategy is a stronger predictor of survival than a standard imaging strategy in patients with head and neck squamous cell carcinoma",
abstract = "Our purpose was to examine whether staging of head and neck squamous cell carcinoma (HNSCC) by upfront 18F-FDG PET/CT (i.e., on the day of biopsy and before the biopsy) discriminates survival better than the traditional imaging strategies based on chest x-ray plus head and neck MRI (CXR/MRI) or chest CT plus head and neck MRI (CCT/MRI). Methods: We performed a masked prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited from Odense University Hospital from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/ MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I and II), locally advanced (stages III and IVB), or metastatic (stage IVC). Discriminative ability for each imaging modality with respect to HNSCC staging were compared using Kaplan–Meier analysis, Cox proportional hazards regression with the Harrell C-index, and net reclassification improvement. Results: In total, 307 patients with histologically verified HNSCC were included. Use of PET/CT significantly altered the stratification of tumor stage when compared with either CXR/MRI or CCT/MRI (x 2, P, 0.001 for both). Cancer stages based on PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk on Kaplan–Meier analyses (P # 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/ CT (C-index, 0.712) than for CXR/MRI (C-index, 0.675; P 5 0.04) or CCT/MRI (C-index, 0.657; P 5 0.02). Finally, PET/CT was significantly associated with a positive net reclassification improvement when compared with CXR/MRI (0.184, P 5 0.03) but not CCT/MRI (0.094{\%}, P 5 0.31). Conclusion: Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies.",
keywords = "Computed tomography, Head, Magnetic resonance imaging, Neck squamous cell carcinoma, Positron emission tomography, Staging, Survival",
author = "Max Rohde and Nielsen, {Anne L} and Manan Pareek and J{\o}rgen Johansen and S{\o}rensen, {Jens A} and Anabel Diaz and Nielsen, {Mie K} and Christiansen, {Janus M} and Asmussen, {Jon T} and Nina Nguyen and Oke Gerke and Anders Thomassen and Abass Alavi and H{\o}ilund-Carlsen, {Poul Flemming} and Christian Godballe",
note = "Copyright {\circledC} 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.",
year = "2018",
month = "4",
day = "1",
doi = "10.2967/jnumed.117.197350",
language = "English",
volume = "59",
pages = "575--581",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine",
number = "4",

}

A PET/CT-based strategy is a stronger predictor of survival than a standard imaging strategy in patients with head and neck squamous cell carcinoma. / Rohde, Max; Nielsen, Anne L; Pareek, Manan; Johansen, Jørgen; Sørensen, Jens A; Diaz, Anabel; Nielsen, Mie K; Christiansen, Janus M; Asmussen, Jon T; Nguyen, Nina; Gerke, Oke; Thomassen, Anders; Alavi, Abass; Høilund-Carlsen, Poul Flemming; Godballe, Christian.

I: Journal of Nuclear Medicine, Bind 59, Nr. 4, 01.04.2018, s. 575-581.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - A PET/CT-based strategy is a stronger predictor of survival than a standard imaging strategy in patients with head and neck squamous cell carcinoma

AU - Rohde, Max

AU - Nielsen, Anne L

AU - Pareek, Manan

AU - Johansen, Jørgen

AU - Sørensen, Jens A

AU - Diaz, Anabel

AU - Nielsen, Mie K

AU - Christiansen, Janus M

AU - Asmussen, Jon T

AU - Nguyen, Nina

AU - Gerke, Oke

AU - Thomassen, Anders

AU - Alavi, Abass

AU - Høilund-Carlsen, Poul Flemming

AU - Godballe, Christian

N1 - Copyright © 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Our purpose was to examine whether staging of head and neck squamous cell carcinoma (HNSCC) by upfront 18F-FDG PET/CT (i.e., on the day of biopsy and before the biopsy) discriminates survival better than the traditional imaging strategies based on chest x-ray plus head and neck MRI (CXR/MRI) or chest CT plus head and neck MRI (CCT/MRI). Methods: We performed a masked prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited from Odense University Hospital from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/ MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I and II), locally advanced (stages III and IVB), or metastatic (stage IVC). Discriminative ability for each imaging modality with respect to HNSCC staging were compared using Kaplan–Meier analysis, Cox proportional hazards regression with the Harrell C-index, and net reclassification improvement. Results: In total, 307 patients with histologically verified HNSCC were included. Use of PET/CT significantly altered the stratification of tumor stage when compared with either CXR/MRI or CCT/MRI (x 2, P, 0.001 for both). Cancer stages based on PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk on Kaplan–Meier analyses (P # 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/ CT (C-index, 0.712) than for CXR/MRI (C-index, 0.675; P 5 0.04) or CCT/MRI (C-index, 0.657; P 5 0.02). Finally, PET/CT was significantly associated with a positive net reclassification improvement when compared with CXR/MRI (0.184, P 5 0.03) but not CCT/MRI (0.094%, P 5 0.31). Conclusion: Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies.

AB - Our purpose was to examine whether staging of head and neck squamous cell carcinoma (HNSCC) by upfront 18F-FDG PET/CT (i.e., on the day of biopsy and before the biopsy) discriminates survival better than the traditional imaging strategies based on chest x-ray plus head and neck MRI (CXR/MRI) or chest CT plus head and neck MRI (CCT/MRI). Methods: We performed a masked prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited from Odense University Hospital from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/ MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I and II), locally advanced (stages III and IVB), or metastatic (stage IVC). Discriminative ability for each imaging modality with respect to HNSCC staging were compared using Kaplan–Meier analysis, Cox proportional hazards regression with the Harrell C-index, and net reclassification improvement. Results: In total, 307 patients with histologically verified HNSCC were included. Use of PET/CT significantly altered the stratification of tumor stage when compared with either CXR/MRI or CCT/MRI (x 2, P, 0.001 for both). Cancer stages based on PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk on Kaplan–Meier analyses (P # 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/ CT (C-index, 0.712) than for CXR/MRI (C-index, 0.675; P 5 0.04) or CCT/MRI (C-index, 0.657; P 5 0.02). Finally, PET/CT was significantly associated with a positive net reclassification improvement when compared with CXR/MRI (0.184, P 5 0.03) but not CCT/MRI (0.094%, P 5 0.31). Conclusion: Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies.

KW - Computed tomography

KW - Head

KW - Magnetic resonance imaging

KW - Neck squamous cell carcinoma

KW - Positron emission tomography

KW - Staging

KW - Survival

U2 - 10.2967/jnumed.117.197350

DO - 10.2967/jnumed.117.197350

M3 - Journal article

C2 - 28864630

VL - 59

SP - 575

EP - 581

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 4

ER -