Prognostic value of pretreatment 18F-FDG PET/CT and human papillomavirus type 16 testing in locally advanced oropharyngeal squamous cell carcinoma

• Published in: European journal of nuclear medicine and molecular imaging Vol. 39; no. 11; pp. 1673 - 1684
• Main Authors: Cheng, Nai-Ming, Chang, Joseph Tung-Chieh, Huang, Chung-Guei, Tsan, Din-Li, Ng, Shu-Hang, Wang, Hung-Ming, Liao, Chun-Ta, Lin, Chien-Yu, Hsu, Cheng-Lung, Yen, Tzu-Chen
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.11.2012
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - virology; Cardiology; Female; Fluorodeoxyglucose F18; Human papillomavirus 16 - isolation & purification; Human Papillomavirus DNA Tests; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging; Nuclear Medicine; Oncology; Original Article; Oropharyngeal Neoplasms - diagnosis; Oropharyngeal Neoplasms - diagnostic imaging; Oropharyngeal Neoplasms - virology; Orthopedics; Papillomavirus Infections - diagnosis; Positron-Emission Tomography; Prognosis; Radiology; Radiopharmaceuticals; Retrospective Studies; Tomography, X-Ray Computed; Prognosis; Total lesion glycolysis; Standardized uptake value; PET/CT; FDG; Head and neck; Oropharyngeal carcinoma; HPV
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-012-2186-9

Purpose Human papillomavirus type 16 (HPV-16) positivity is associated with favourable survival in oropharyngeal squamous cell carcinoma (OPSCC). We report here a study of the prognostic significance of 18 F-FDG PET/CT functional parameters and HPV-16 infection in OPSCC patients. Methods We retrospectively analysed 60 patients with stage III or IV OPSCC who had had a pretherapy 18 F-FDG PET/CT scan and had completed concurrent chemoradiotherapy ( n  = 58) or curative radiotherapy ( n  = 2). All patients were followed up for ≥24 months or until death. We determined total lesion glycolysis (TLG) and the maximal standardized uptake values (SUV max ) of the primary tumour and neck lymph nodes from the pretherapy 18 F-FDG PET/CT scan. Optimal cut-offs of the 18 F-FDG PET/CT parameters were obtained by receiver operating characteristic (ROC) curve analyses. Pretherapy tumour biopsies were studied by polymerase chain reaction to determine HPV infection status. Results The pretherapy tumour biopsies were positive for HPV-16 in 12 patients (20.0 %). Cox regression analyses revealed HPV-16 positivity and tumour TLG >135.3 g to be independently associated with overall survival ( p  = 0.027 and 0.011, respectively). However, only tumour TLG >135.3 g was independently associated with progression-free survival, disease-free survival and locoregional control ( p  = 0.011, 0.001 and 0.034, respectively). A scoring system was formulated to define distinct overall survival groups using tumour TLG and HPV-16 status. Patients positive for HPV-16 and with tumour TLG ≤135.3 g experienced better survival than those with tumour TLG >135.3 g and no HPV infection ( p  = 0.001). Conclusion Tumour TLG was an independent predictor of survival in patients with locally advanced OPSCC. A scoring system was developed and may serve as a risk stratification strategy for guiding therapy.