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
SN - 0161-5505
VL - 59
SP - 575
EP - 581
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 4
ER -