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Heterogeneity of 18 F‐FDG PET combined with expression of EGFR may improve the prognostic stratification of advanced oropharyngeal carcinoma
Author(s) -
Wang HungMing,
Cheng NaiMing,
Lee LiYu,
Fang YuHua Dean,
Chang Joseph TungChieh,
Tsan DinLi,
Ng ShuHang,
Liao ChunTa,
Yang LanYan,
Yen TzuChen
Publication year - 2015
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29811
Subject(s) - medicine , oncology , risk stratification , carcinoma , positron emission tomography , stratification (seeds) , pathology , nuclear medicine , biology , seed dormancy , botany , germination , dormancy
The Ang's risk profile (based on p16, smoking and cancer stage) is a well‐known prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). Whether heterogeneity in 18 F‐fluorodeoxyglucose (FDG) positron emission tomographic (PET) images and epidermal growth factor receptor (EGFR) expression could provide additional information on clinical outcomes in advanced‐stage OPSCC was investigated. Patients with stage III–IV OPSCC who completed primary therapy were eligible. Zone‐size nonuniformity (ZSNU) extracted from pretreatment FDG PET scans was used as an index of image heterogeneity. EGFR and p16 expression were examined by immunohistochemistry. Disease‐specific survival (DSS) and overall survival (OS) served as outcome measures. Kaplan–Meier estimates and Cox proportional hazards regression models were used for survival analysis. A bootstrap resampling technique was applied to investigate the stability of outcomes. Finally, a recursive partitioning analysis (RPA)‐based model was constructed. A total of 113 patients were included, of which 28 were p16‐positive. Multivariate analysis identified the Ang's profile, EGFR and ZSNU as independent predictors of both DSS and OS. Using RPA, the three risk factors were used to devise a prognostic scoring system that successfully predicted DSS in both p16‐positive and ‐negative cases. The c ‐statistic of the prognostic index for DSS was 0.81, a value which was significantly superior to both AJCC stage (0.60) and the Ang's risk profile (0.68). In patients showing an Ang's high‐risk profile ( N = 77), the use of our scoring system clearly identified three distinct prognostic subgroups. It was concluded that a novel index may improve the prognostic stratification of patients with advanced‐stage OPSCC.