A PET/CT-Based Strategy Is a Stronger Predictor of Survival Than a Standard Imaging Strategy in Patients with Head and Neck Squamous Cell Carcinoma

Abstract

Our purpose was to examine whether staging of head and neck squamous cell carcinoma (HNSCC) by upfront F-FDG PET/CT (i.e., on the day of biopsy and before the biopsy) discriminates survival better than the traditional imaging strategies based on chest x-ray plus head and neck MRI (CXR/MRI) or chest CT plus head and neck MRI (CCT/MRI). We performed a masked prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited from Odense University Hospital from September 2013 to March 2016. All patients underwent CXR/MRI, CCT/MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I and II), locally advanced (stages III and IVB), or metastatic (stage IVC). Discriminative ability for each imaging modality with respect to HNSCC staging were compared using Kaplan-Meier analysis, Cox proportional hazards regression with the Harrell C-index, and net reclassification improvement. In total, 307 patients with histologically verified HNSCC were included. Use of PET/CT significantly altered the stratification of tumor stage when compared with either CXR/MRI or CCT/MRI (χ, < 0.001 for both). Cancer stages based on PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk on Kaplan-Meier analyses ( ≤ 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/CT (C-index, 0.712) than for CXR/MRI (C-index, 0.675; = 0.04) or CCT/MRI (C-index, 0.657; = 0.02). Finally, PET/CT was significantly associated with a positive net reclassification improvement when compared with CXR/MRI (0.184, = 0.03) but not CCT/MRI (0.094%, = 0.31). Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies.

Diagnostic Accuracy of Up-Front PET/CT and MRI for Detecting Cervical Lymph Node Metastases in T1–T2 Oral Cavity Cancer—A Prospective Cohort Study

“…In a prospective cohort study from 2017, Rohde et al [43] concluded that PET/CT has a significantly higher detection rate of distant metastases or synchronous cancers than chest CT/head and neck MRI for patients with oral cavity cancer (T1-T4). The detection of distant metastasis and synchronous cancers at the time of diagnosis has a significant impact on treatment decisions and prognosis [20,44]. This qualifies more for a valid argument in favor of up-front PET/CT than of an improved sensitivity in detecting cervical lymph node metastases, as PET/CT has the significant impact of M-classification, thus affecting treatment planning for patients with OSCC.…”

PET/CT Versus Standard Imaging for Prediction of Survival in Patients with Recurrent Head and Neck Squamous Cell Carcinoma

“…We conducted a masked prospective cohort study based on paired data. The overall cohort has previously been used for publications concerning patients with primary HNSCC (22)(23)(24). This study examined recurrent HNSCC, which constituted a different subgroup of patients from our overall cohort.…”