体积及基于体素的[18F]FDG-PET指标在头颈癌中的预后价值
Prognostic Value of Volumetric and Voxel-Based [18F]FDG-PET Metrics in Head and Neck Cancer.
文献信息
| PMID | 42976257 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Andrej Doma |
| 作者单位 | Institute of Oncology Ljubljana, Department of Nuclear Medicine, Ljubljana, Slovenia. |
| 期刊 | Technology in cancer research & treatment |
| SCI 分区 | Q3 |
| IF | 2.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
引言： 在头颈癌（HNC）中，[18F]FDG PET/CT SUVmax的预后价值有限。代谢肿瘤体积（MTV）和瘦体重归一化SUV（SUL）等体积参数可能改善风险分层，尤其是在体重指数较高的患者中。
方法： 我们开展了一项回顾性队列研究，纳入28例经组织学证实为非转移性鳞状细胞HNC、接受治疗前[18F]FDG PET/CT及根治性（放化疗）的患者。测量原发肿瘤（P）、颈部淋巴结（N）和总（T）MTV、SUVmax和SULmax。采用logistic回归、受试者工作特征（ROC）分析和Kaplan-Meier曲线评估其与2.5年总生存（OS2.5）、局部（LOC）、区域（REG）和远处（M+）失败的相关性。统计分析在R（v3.5）中进行；p < 0.05视为具有统计学显著性。
结果： 中位年龄为55岁（IQR，45-65），大多数患者为女性（78.6%）。原发肿瘤部位为鼻咽（57.1%）或口咽（39.3%）；1例患者原发肿瘤不明。所有肿瘤均为鳞状细胞癌。中位随访时间为37.6个月，11例患者（39%）死亡。MTV-T与OS2.5的相关性最强（AUC 0.85，阈值14 ml，p = 0.003），其次是SULmax-N（AUC 0.78，p = 0.025）、SUVmax-N和MTV-P（两者AUC均为0.77，p = 0.03）。对于远处失败，SULmax-N和SUVmax-N是最强预测因子（两者AUC均为0.90，p = 0.0012），优于体积参数。基于体素的原发肿瘤摄取指标不能预测局部或区域失败，后者与T和N分期及MTV-P相关。SUL指标与体重归一化SUV高度相关（r=0.99-1.00），但无判别优势。
结论： 在总生存预测方面，体积PET参数优于基于体素的摄取指标，而淋巴结SULmax和SUVmax对远处失败的预测更好。瘦体重归一化并未改善预后性能。这些发现支持将PET衍生的体积和代谢强度参数用于风险分层，并需要在更大队列中验证。
英文摘要
IntroductionIn head and neck cancer (HNC), the prognostic value of [18F]FDG PET/CT SUVmax is limited. Volumetric parameters such as metabolic tumor volume (MTV) and lean body mass-normalized SUV (SUL) may improve risk stratification, particularly in patients with higher body mass index.MethodsWe conducted a retrospective cohort study of 28 patients with histologically confirmed non-metastatic squamous cell HNC undergoing pretreatment [18F]FDG PET/CT and definitive (chemo)radiotherapy. Primary tumor (P), neck nodal (N), and total (T) MTV, SUVmax, and SULmax were measured. Associations with 2.5-year overall survival (OS2.5), local (LOC), regional (REG), and distant (M+) failure were assessed using logistic regression, receiver operating characteristic (ROC) analysis, and Kaplan-Meier curves. Statistical analyses were performed in R (v3.5); p < 0.05 considered statistically significant.ResultsThe median age was 55 years (IQR, 45-65), and most patients were female (78.6%). Primary tumor sites were nasopharynx (57.1%) or oropharynx (39.3%); one patient had an unknown primary tumor. All tumors were squamous cell carcinomas. Median follow-up was 37.6 months and 11 patients (39%) died. MTV-T showed the strongest association with OS2.5 (AUC 0.85, threshold 14 ml, p = 0.003), followed by SULmax-N (AUC 0.78, p = 0.025), SUVmax-N, and MTV-P (both AUC 0.77, p = 0.03). For distant failure, SULmax-N and SUVmax-N were the strongest predictors (both AUC 0.90, p = 0.0012), outperforming volumetric parameters. Voxel-based primary tumor uptake metrics did not predict local or regional failure, which were associated with T and N stage and MTV-P. SUL metrics showed high correlation with body weight-normalized SUVs (r=0.99-1.00) but no discriminatory advantage.ConclusionVolumetric PET parameters outperformed voxel-based uptake metrics for overall survival prediction, while nodal SULmax and SUVmax better predicted distant failure. Lean body mass normalization did not improve prognostic performance. These findings support PET-derived volumetric and metabolic intensity parameters for risk stratification and require validation in larger cohorts.