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Tumor heterogeneity measured on F‐18 fluorodeoxyglucose positron emission tomography/computed tomography combined with plasma Epstein‐Barr Virus load predicts prognosis in patients with primary nasopharyngeal carcinoma
Author(s) -
Chan ShengChieh,
Chang KaiPing,
Fang YuHua Dean,
Tsang NganMing,
Ng ShuHang,
Hsu ChengLung,
Liao ChunTa,
Yen TzuChen
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26172
Subject(s) - nasopharyngeal carcinoma , positron emission tomography , computed tomography , epstein–barr virus , positron emission tomography computed tomography , medicine , nuclear medicine , fluorodeoxyglucose , radiology , virus , virology , radiation therapy
Objectives/Hypothesis Plasma Epstein‐Barr virus (EBV) DNA concentrations predict prognosis in patients with nasopharyngeal carcinoma (NPC). Recent evidence also indicates that intratumor heterogeneity on F‐18 fluorodeoxyglucose positron emission tomography ( 18 F‐FDG PET) scans is predictive of treatment outcomes in different solid malignancies. Here, we sought to investigate the prognostic value of heterogeneity parameters in patients with primary NPC. Study Design Retrospective cohort study. Methods We examined 101 patients with primary NPC who underwent pretreatment 18 F‐FDG PET/computed tomography. Circulating levels of EBV DNA were measured in all participants. The following PET heterogeneity parameters were collected: histogram‐based heterogeneity parameters, second‐order texture features (uniformity, contrast, entropy, homogeneity, dissimilarity, inverse difference moment), and higher‐order (coarseness, contrast, busyness, complexity, strength) texture features. Results The median follow‐up time was 5.14 years. Total lesion glycolysis (TLG), tumor heterogeneity measured by histogram‐based parameter skewness, and the majority of second‐order or higher‐order texture features were significantly associated with overall survival (OS) and/or recurrence‐free survival (RFS). In multivariate analysis, age ( P =.005), EBV DNA load ( P = .0002), and uniformity ( P = .001) independently predicted OS. Only skewness retained the independent prognostic significance for RFS. Tumor stage, standardized uptake value, or TLG did not show an independent association with survival endpoints. The combination of uniformity, EBV DNA load, and age resulted in a more reliable prognostic stratification ( P < .001). Conclusions Tumor heterogeneity is superior to traditional PET parameters for predicting outcomes in primary NPC. The combination of uniformity with EBV DNA load can improve prognostic stratification in this clinical entity. Level of Evidence 4 Laryngoscope , 127:E22–E28, 2017