FDG PET-CT对复发鼻咽癌疗效及预后评价研究

Value of FDG PET-CT in outcome assessment and prognostic evaluation for recurrent nasopharyngeal carcinoma

目的 评价FDG PET-CT显像对复发鼻咽癌疗效监测及其预后评估价值.方法 2008-2013年经病理或影像学确诊的92例复发鼻咽癌,按中国2008鼻咽癌临床分期标准再分期.Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为8、11、39、34例,其中复发T分期（rT1）、rT2、rT3、rT4期患者分别为10、11、38、33例.28例同时伴有颈淋巴结复发.所有患者均于疗前行全身或头颈部FDG PET-CT并接受放疗±化疗,分别分析SUVmax及临床各因素与临床预后关系.Kaplan-Meier法计算OS、DFS、LRFS、RRFS、DMFS,Logrank法检验和单因素预后分析,Cox模型多因素预后分析.结果 3年OS、DFS、LRFS、RRFS、DMFS分别为33.6％、32.1％、32.8％、31.8％、33.7％.肿瘤SUVmax中位数为8.35（2.70～21.50）.与3年OS相关最佳截断点SUVmax为7.0,SUVmax≤7.0、＞7.0患者3年OS分别为42.0％、28.3％（P=0.019）.单因素分析显示年龄、SUVmax、rN分期与OS相关（P=0.023、0.019、0.002）,多因素分析显示SUVmax和rN分期是OS、DFS、DMFS影响因素（HR=1.68,P=O.045和HR=2.23,P=0.003;HR=1.67,P=0.042和HR=2.39,P=0.001;HR=1.77,P=0.025和HR=2.40,P=0.001）.结论 SUVmax可能是影响复发鼻咽癌OS、DFS、DMFS的有效预后因素.

Objective To investigate the value of FDG PET-CT in the outcome assessment and prognostic evaluation for recurrent nasopharyngeal carcinoma （rNPC）.Methods From January 2008 to December 2013,92 rNPC patients were treated in our center,who were histologically or radiologically diagnosed and re-staged according to the 2008 clinical staging system for nasopharyngeal carcinoma in China.The numbers of patients in stage Ⅰ,stage Ⅱ,stage Ⅲ,and stage Ⅳ were 8,11,39,and 34,respectively.According to the recurrent T stage （rT）,the numbers of patients in rT1,rT2,rT3,and rT4 were 10,11,38,and 33,respectively.Twenty-eight patients had recurrence in the neck lymph nodes.All patients underwent pretreatment FDG PET-CT for the whole body or head/neck,and treated by radiotherapy with or without chemotherapy.The relationship of maximum standard uptake value （SUVmax） and clinical factors with clinical outcomes was analyzed.The Kaplan-Meier method was used to calculate overall survival （OS）,disease-free survival （DFS）,local recurrence-free survival （LRFS）,regional recurrence-free survival （RRFS）,and distant metastasis-free survival （DMFS）.The log-rank test was used for survival difference analysis and univariate prognostic analysis.The Cox model was used for multivariate prognostic analysis.Results The 3-year OS,DFS,LRFS,RRFS,and DMFS were 33.6％,32.1％,32.8％,31.8％,and 33.7％,respectively.The median SUVmax was 8.35 （2.7-21.5）.The SUVmax of 7.0 was taken as the optimal cut-off value for all patients.Patients with SUVmax ≤7.0 had a significantly higher 3-year OS rate than those with SUVm ax ＞7.0 （42.0％ vs.28.3％,P=0.019）.The univariate analysis revealed that patient age,SUV and rN were significantly associated with OS （P=0.023,0.019,and 0.002）.The multivariate analysis showed that SUVmax and rN were significant influencing factors for OS,DFS,and DMFS （HR=1.68,P=0.045 and HR=2.23,P=0.003;HR=1.67,P=0.042 and HR=2.39,P=0.001;HR=1.77,P=0.025 and HR=2.40,P=0.001）.Conclusions SUVmax may be one of the useful prognostic factors for OS,DFS,and DMFS in rNPC patients.