scholarly journals Development and validation of radiologic scores for guiding individualized induction chemotherapy in T3N1M0 nasopharyngeal carcinoma

Author(s):  
Shan-Shan Yang ◽  
Yi-Shan Wu ◽  
Ya-Jun Pang ◽  
Su-Ming Xiao ◽  
Bao-Yu Zhang ◽  
...  

Abstract Objectives We aimed to develop and validate radiologic scores from [18F]FDG PET/CT and MRI to guide individualized induction chemotherapy (IC) for patients with T3N1M0 nasopharyngeal carcinoma (NPC). Methods A total of 542 T3N1M0 patients who underwent pretreatment [18F]FDG PET/CT and MRI were enrolled in the training cohort. A total of 174 patients underwent biopsy of one or more cervical lymph nodes. Failure-free survival (FFS) was the primary endpoint. The radiologic score, which was calculated according to the number of risk factors from the multivariate model, was used for risk stratification. The survival difference of patients undergoing concurrent chemoradiotherapy (CCRT) with or without IC was then compared in risk-stratified subgroups. Another cohort from our prospective clinical trial (N = 353, NCT03003182) was applied for validation. Results The sensitivity of [18F]FDG PET/CT was better than that of MRI (97.7% vs. 87.1%, p < 0.001) for diagnosing histologically proven metastatic cervical lymph nodes. Radiologic lymph node characteristics were independent risk factors for FFS (all p < 0.05). High-risk patients (n = 329) stratified by radiologic score benefited from IC (5-year FFS: IC + CCRT 83.5% vs. CCRT 70.5%; p = 0.0044), while low-risk patients (n = 213) did not. These results were verified again in the validation cohort. Conclusions T3N1M0 patients were accurately staged by both [18F]FDG PET/CT and MRI. The radiologic score can correctly identify high-risk patients who can gain additional survival benefit from IC and it can be used to guide individualized treatment of T3N1M0 NPC. Key Points • [18F]FDG PET/CT was more accurate than MRI in diagnosing histologically proven cervical lymph nodes. • Radiologic lymph node characteristics were reliable independent risk factors for FFS in T3N1M0 nasopharyngeal carcinoma patients. • High-risk patients identified by the radiologic score based on [18F]FDG PET/CT and MRI could benefit from the addition of induction chemotherapy.

2021 ◽  
Author(s):  
Shan-Shan Yang ◽  
Yi-Shan Wu ◽  
Wei-Chao Chen ◽  
Jun Zhang ◽  
Su-Ming Xiao ◽  
...  

Abstract Background We aimed to testify the advantage of positron emission tomography and computed tomography(PET/CT) in diagnosing cervical lymph nodes and staging nasopharyngeal carcinoma, and investigate whether PET/CT could bring about benefit in survival and serve for individualized treatment. Methods A total of 2759 patients were enrolled in this study. 460 biopsied cervical lymph nodes were named cohort A. Cohort B consisted of 1093 T3N1M0 patients who received both PET/CT and magnetic resonance imaging(MRI), while Cohort C contained 1377 T3N1M0 patients who underwent MRI alone. Cohort D enrolled 838 patients receiving concurrent chemoradiotherapy(CCRT) with or without induction chemotherapy(IC) to develop radiologic score model to guide IC. Results In cohort A, the sensitivity, accuracy, and area under the curve of PET/CT were much higher than those of MRI (96.7%versus88.5%, p < 0.001; 88.0%versus81.1%,p < 0.001; 0.863versus0.796,p < 0.05) in diagnosing metastatic lymph nodes. In cohort B, MRI staged T3N0-3M0 patients showed non-different survival rates, as they were the same T3N1M0 if staged by PET/CT. Besides, patients staged by PET/CT + 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. Radiologic score model based on these factors performed well(C-index = 0.72) in risk stratification. The identified high-risk patients undergoing IC + CCRT had higher 5-year failure-free survival than those receiving CCRT alone(p = 0.0064). Conclusion PET/CT showed advantage in staging by accurate diagnosis of lymph nodes and contributed to survival benefit. PET/CT carried prognostic factor could identify high-risk patients and guide individualized treatment.


2019 ◽  
Vol 213 (4) ◽  
pp. 918-924 ◽  
Author(s):  
Yoshiaki Abe ◽  
Kentaro Narita ◽  
Hiroki Kobayashi ◽  
Akihiro Kitadate ◽  
Masami Takeuchi ◽  
...  

Author(s):  
Shan-Shan Yang ◽  
Yi-Shan Wu ◽  
Wei-Chao Chen ◽  
Jun Zhang ◽  
Su-Ming Xiao ◽  
...  

Abstract 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.


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