PLoS ONE (Jan 2020)

Prognostic value of baseline [18F]-fluorodeoxyglucose positron emission tomography parameters MTV, TLG and asphericity in an international multicenter cohort of nasopharyngeal carcinoma patients.

  • Sebastian Zschaeck,
  • Yimin Li,
  • Qin Lin,
  • Marcus Beck,
  • Holger Amthauer,
  • Laura Bauersachs,
  • Marina Hajiyianni,
  • Julian Rogasch,
  • Vincent H Ehrhardt,
  • Goda Kalinauskaite,
  • Julian Weingärtner,
  • Vivian Hartmann,
  • Jörg van den Hoff,
  • Volker Budach,
  • Carmen Stromberger,
  • Frank Hofheinz

DOI
https://doi.org/10.1371/journal.pone.0236841
Journal volume & issue
Vol. 15, no. 7
p. e0236841

Abstract

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Purpose[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) parameters have shown prognostic value in nasopharyngeal carcinomas (NPC), mostly in monocenter studies. The aim of this study was to assess the prognostic impact of standard and novel PET parameters in a multicenter cohort of patients.MethodsThe established PET parameters metabolic tumor volume (MTV), total lesion glycolysis (TLG) and maximal standardized uptake value (SUVmax) as well as the novel parameter tumor asphericity (ASP) were evaluated in a retrospective multicenter cohort of 114 NPC patients with FDG-PET staging, treated with (chemo)radiation at 8 international institutions. Uni- and multivariable Cox regression and Kaplan-Meier analysis with respect to overall survival (OS), event-free survival (EFS), distant metastases-free survival (FFDM), and locoregional control (LRC) was performed for clinical and PET parameters.ResultsWhen analyzing metric PET parameters, ASP showed a significant association with EFS (p = 0.035) and a trend for OS (p = 0.058). MTV was significantly associated with EFS (p = 0.026), OS (p = 0.008) and LRC (p = 0.012) and TLG with LRC (p = 0.019). TLG and MTV showed a very high correlation (Spearman's rho = 0.95), therefore TLG was subesequently not further analysed. Optimal cutoff values for defining high and low risk groups were determined by maximization of the p-value in univariate Cox regression considering all possible cutoff values. Generation of stable cutoff values was feasible for MTV (p55 years + one binarized PET parameter), MTV >11.1ml (hazard ratio (HR): 3.57, p 14.4% (HR: 3.2, p = 0.031) remained prognostic for OS. MTV additionally remained prognostic for LRC (HR: 4.86 pConclusionsIn this analysis, PET parameters were associated with outcome of NPC patients. MTV showed a robust association with OS, EFS and LRC. Our data suggest that combination of MTV and ASP may potentially further improve the risk stratification of NPC patients.