Benefit of [18F]-FDG PET/CT for treatment-naïve nasopharyngeal carcinoma

• Published in: European journal of nuclear medicine and molecular imaging Vol. 49; no. 3; pp. 980 - 991
• Main Authors: Yang, Shan-Shan, Wu, Yi-Shan, Chen, Wei-Chao, Zhang, Jun, Xiao, Su-Ming, Zhang, Bao-Yu, Liu, Zhi-Qiao, Chen, En-Ni, Zhang, Xu, OuYang, Pu-Yun, Xie, Fang-Yun
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2022; Springer Nature B.V
• Subjects: Cancer; Cardiology; Chemotherapy; Computed tomography; Diagnosis; DNA viruses; Emission analysis; Epstein-Barr virus; Epstein-Barr Virus Infections - pathology; Fluorodeoxyglucose F18; Herpesvirus 4, Human; Humans; Imaging; Lymph nodes; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Lymphatic system; Magnetic resonance imaging; Medical prognosis; Medicine; Medicine & Public Health; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - diagnostic imaging; Nasopharyngeal Carcinoma - therapy; Nasopharyngeal Neoplasms - diagnostic imaging; Nasopharyngeal Neoplasms - therapy; Necrosis; Neoplasm Staging; Nuclear Medicine; Oncology; Oncology – Head and Neck; Original; Original Article; Orthopedics; Patients; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Positron-Emission Tomography - methods; Radiology; Risk; Risk groups; Sensitivity and Specificity; Survival; Throat cancer; Tomography; Nasopharyngeal carcinoma; Induction chemotherapy; MRI; PET/CT
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-021-05540-8

Background To test the advantages of positron emission tomography and computed tomography (PET/CT) for diagnosing lymph nodes and staging nasopharyngeal carcinoma and to investigate its benefits for survival and treatment decisions. Methods The performance of PET/CT and magnetic resonance imaging (MRI) in diagnosis was compared based on 460 biopsied lymph nodes. Using the propensity matching method, survival differences of T3N1M0 patients with ( n  = 1093) and without ( n  = 1377) PET/CT were compared in diverse manners. A radiologic score model was developed and tested in a subset of T3N1M0 patients. Results PET/CT performed better than MRI with higher sensitivity, accuracy, and area under the receiver operating characteristic curve (96.7% vs. 88.5%, p  < 0.001; 88.0% vs. 81.1%, p  < 0.001; 0.863 vs. 0.796, p  < 0.05) in diagnosing lymph nodes. Accordingly, MRI-staged T3N0-3M0 patients showed nondifferent survival rates, as they were the same T3N1M0 if staged by PET/CT. In addition, patients staged by PET/CT and MRI showed higher survival rates than those staged by MRI alone ( p  < 0.05), regardless of the Epstein-Barr virus DNA load. Interestingly, SUVmax-N, nodal necrosis, and extranodal extension were highly predictive of survival. The radiologic score model based on these factors performed well in risk stratification with a C-index of 0.72. Finally, induction chemotherapy showed an added benefit ( p  = 0.006) for the high-risk patients selected by the model but not for those without risk stratification ( p  = 0.78). Conclusion PET/CT showed advantages in staging nasopharyngeal carcinoma due to a more accurate diagnosis of lymph nodes and this contributed to a survival benefit. PET/CT combined with MRI provided prognostic factors that could identify high-risk patients and guide individualized treatment.