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PET/CT versus standard imaging for prediction of survival in patients with recurrent head and neck squamous cell carcinoma

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review


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  • Max Rohde
  • Anne L Nielsen
  • Manan Pareek
  • Jørgen Johansen
  • Jens A Sørensen
  • Anabel Diaz
  • Mie K Nielsen
  • Janus Mølgaard Christiansen
  • Jon T Asmussen
  • Nina Nguyen
  • Oke Gerke
  • Anders Thomassen
  • Abass Alavi
  • Poul Flemming Høilund-Carlsen
  • Christian Godballe
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Purpose: To examine whether staging with 18F-FDG-PET/CT (PET/CT) provides better prediction of survival in patients with recurrent head and neck squamous cell carcinoma (HNSCC) than chest X-ray + head and neck magnetic resonance imaging (CXR/MRI) or chest computed tomography + head and neck MRI (CCT/MRI). Methods: A prospective cohort study based on paired data. Consecutive patients with histologically verified HNSCC recurrence were enrolled from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/MRI, and PET/CT on the same day and prior to biopsy. All imaging studies were interpreted blindly by separate teams of experienced nuclear physicians and/or radiologists. Recurrent carcinomas were categorized as localized (equivalent to primary stages I-II), locally advanced (equivalent to primary stages III-IVB), or metastatic (equivalent to primary stage IVC). Discriminative abilities for each imaging strategy with respect to cancer-specific and stage-based survival were compared using Kaplan-Meier analysis, Cox proportional-hazards regression with Harrell's C-index, and net reclassification improvement (NRI). Results: A total of 110 patients (90 males and 20 females, aged 66 y, range 40-87) were included. PET/CT significantly changed the assigned tumor stage when compared with imaging strategies based on CXR/MRI or CCT/MRI (p<0.001 for both). Kaplan-Meier analysis of PET/CT-based staging showed progressively worsened prognosis with localized, locally advanced, or metastatic disease (log-rank test: p<0.001), whereas CXR/MRI and CCT/MRI were unable to distinguish between these groups in terms of survival (log-rank test: P = 0.18 and P = 0.58). Overall discriminative ability in predicting cancer-specific mortality was significantly greater for PET/CT (C-index: 0.72) than for CXR/MRI (C-index: 0.55, P = 0.001 for difference) and CCT/MRI (C-index: 0.55, p<0.001 for difference). The addition of PET/CT to either CXR/MRI or CCT/MRI was associated with a significantly positive NRI (p<0.001 for both). Conclusion: Contrary to standard imaging strategies, PET/CT-based staging in recurrent HNSCC was able to discriminate significantly between survival courses of patients with local, locally advanced or metastatic disease and predict their respective survival probability.

TidsskriftJournal of nuclear medicine : official publication, Society of Nuclear Medicine
Udgave nummer5
Sider (fra-til)592-599
StatusUdgivet - 2019

ID: 56444710