Intratumoural heterogeneity measured using FDG PET and MRI is associated with tumour–stroma ratio and clinical outcome in head and neck squamous cell carcinoma

Choi, Jin Wook; Lee, D.; Hyun, Seung Hyup; Han, Miran; Kim, Jang-Hee; Lee, S.J.

doi:10.1016/j.crad.2017.01.019

Cited by 27 publications

(28 citation statements)

References 34 publications

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“…26 However, the recent advances in head and neck imaging could be used in the near future to accurately estimate the TSR through the analysis of intratumoral heterogeneity. 49 Finally, the reliability of the TSR as prognostic parameter in incisional biopsies of OSCC has not yet been studied.…”

Section: Discussionmentioning

confidence: 99%

Addition of the tumour–stroma ratio to the 8th edition American Joint Committee on Cancer staging system improves survival prediction for patients with oral tongue squamous cell carcinoma

et al. 2020

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Aims One of the objectives of current research is to customise the treatment of cancer patients. The achievement of this objective requires stratification of patients based on the most significant prognostic factors. The aims of this study were to evaluate the prognostic value of the tumour–stroma ratio (TSR), defined as the proportion of tumour cells relative to surrounding stroma, in patients with oral tongue squamous cell carcinoma (OTSCC), and to develop a prognostic nomogram based on the most significant clinicopathological features. Methods and results Clinicopathological data of 211 patients treated at ‘Ospedali Riuniti’ General Hospital (Ancona, Italy) for OTSCC were collected. One hundred and thirty‐nine patients were restaged according to the 8th edition American Joint Committee on Cancer (AJCC) staging system. Evaluation of the TSR was performed on haematoxylin and eosin‐stained slides, and correlation with survival outcomes was evaluated. In addition, with the aim of integrating the independent value of the TSR with the 8th edition AJCC staging system, a prognostic nomogram for OTSCC has been developed. OTSCC with a low TSR (i.e. a high proportion of stroma and a low proportion of tumour cells) was shown to have negative prognostic value in terms of disease‐specific survival, with a hazard ratio (HR) of 1.883 and a 95% confidence interval (CI) of 1.033–3.432 (P = 0.039), and overall survival (HR = 1.747, 95% CI 0.967–3.154; P = 0.044), independently of other histological and clinical parameters. For the cohort of 139 patients restaged according to the 8th edition AJCC staging system, variables correlating with a poor prognosis were: the TSR, perineural invasion, and sex. The nomogram built on these parameters showed good predictive capacity, outperforming the 8th edition AJCC staging system in stratifying disease‐specific survival in OTSCC patients. Conclusions Including the TSR in the predictive model could improve risk stratification of OTSCC patients and aid in making treatment decisions.

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Section: Discussionmentioning

confidence: 99%

Addition of the tumour–stroma ratio to the 8th edition American Joint Committee on Cancer staging system improves survival prediction for patients with oral tongue squamous cell carcinoma

et al. 2020

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“…Previous studies have demonstrated that the intratumoral heterogeneity derived from PET/CT can serve as a prognostic biomarker for treatment outcome in pancreatic cancer [18], uterine leiomyosarcoma [20], head and neck squamous cell carcinoma [23], esophageal cancer [36], oral cavity cancer [37], and epithelial ovarian cancer [38]. Our results showed that the HI of the maximal neck lymph node was significantly associated with the long-term PFS in patients with primary NPC (HR, 3.23; 95% CI, 1.22-8.54; p = 0.018).…”

Section: Discussionmentioning

confidence: 99%

“…18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), which combined anatomical information and metabolic information, has shown value in the assessment of intratumoral heterogeneity [18][19][20]. Some semiquantitative parameters acquired from PET/CT, including the standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI), are demonstrated to be valuable for risk stratification and evaluation of prognosis [21][22][23]. Chung et al [24] investigated the ability of MTV to predict short-term outcome in patients with NPC and found that MTV of > 40 mL was significantly correlation with poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Establishment and validation of a nomogram with intratumoral heterogeneity derived from 18F-FDG PET/CT for predicting individual conditional risk of 5-year recurrence before initial treatment of nasopharyngeal carcinoma

Zhang

et al. 2020

BMC Cancer

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Background: Intratumoral heterogeneity has an enormous effect on patient treatment and outcome. The purpose of the current study was to establish and validate a nomogram with intratumoral heterogeneity derived from 18 Ffluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prognosis of 5-Year progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC).Methods: A total of 171 NPC patients who underwent pretreatment 18 F-FDG PET/CT were retrospectively enrolled. Data was randomly divided into training cohort (n = 101) and validation cohort (n = 70). The clinicopathologic parameters and the following PET parameters were analyzed: maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI, SUVmax/SUVmean) for primary tumor and maximal neck lymph node. Cox analyses were performed on PFS in the training cohort. A prognostic nomogram based on this model was developed and validated. Results: For the primary tumor, MTV-2.5, TLG-2.5, MTV-70%, and TLG-70% were significantly correlated with PFS. For the maximal neck lymph node, short diameter and HI were significantly correlated with PFS. Among the clinicopathologic parameters, M stage was a significant prognostic factor for recurrence. In multivariate analysis, M stage (P = 0.006), TLG-T-70% (P = 0.002), and HI-N (P = 0.018) were independent predictors. Based on this prognostic model, a nomogram was generated. The C-index of this model was 0.74 (95% CI: 0.63-0.85). For the cross validation, the C-index for the model was 0.73 (95% CI: 0.62-0.83) with the validation cohort. Patients with a risk score of ≥111 had poorer survival outcomes than those with a risk score of 0-76 and 77-110.

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“…Previous studies have demonstrated that the intratumoral heterogeneity derived from PET/CT can serve as a prognostic biomarker for treatment outcome in pancreatic cancer [18], uterine leiomyosarcoma [20], head and neck squamous cell carcinoma [23], esophageal cancer [33], oral cavity cancer [35], and epithelial ovarian cancer [36]. Our results showed that the HI of the maximal neck lymph node was significantly associated with the long-term PFS in patients with primary NPC (HR, 3.23; 95% CI, 1.22-8.54; p=0.018).…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Establishment and Validation of a Nomogram with Intratumoral Heterogeneity Derived from 18F-FDG PET/CT for Predicting Individual Conditional Risk of 5-Year Recurrence before Initial Treatment of Nasopharyngeal Carcinoma

Song

et al. 2019

Preprint

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ObjectivesIntratumoral heterogeneity has an enormous effect on patient treatment and outcome. The purpose of the current study was to establish and validate a nomogram with intratumoral heterogeneity derived from 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prognosis of 5-Year progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC).Methods A total of 171 NPC patients who underwent pretreatment 18F-FDG PET/CT were retrospectively enrolled. Data was randomly divided into training cohort (n=101) and validation cohort (n=70). The clinicopathologic parameters and the following PET parameters were analyzed: maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI, SUVmax/SUVmean) for primary tumor and maximal neck lymph node. Cox analyses were performed on PFS in the training cohort. A prognostic nomogram based on this model was developed and validated.ResultsFor the primary tumor, MTV-2.5, TLG-2.5, MTV-70%, and TLG-70% were significantly correlated with PFS. For the maximal neck lymph node, short diameter and HI were significantly correlated with PFS.Among the clinicopathologic parameters, M stage was a significant prognostic factor for recurrence. In multivariate analysis, M stage (P=0.006), TLG-T-70% (P=0.002), and HI-N (P=0.018) were independent predictors. Based on this prognostic model, a nomogram was generated. The C-index of this model was 0.74 (95% CI: 0.63-0.85). For the cross validation, the C-index for the model was 0.73 (95% CI: 0.62-0.83) with the validation cohort. Patients with a risk score of ≥111 had poorer survival outcomes than those with a risk score of 0-76 and 77-110.Conclusions Intratumoral heterogeneity derived from 18F-FDG PET/CT could predict long-term outcome in patients with primary NPC. A combination of PET parameters and the TNM stage enables better stratification of patients into subgroups with different PFS rates. distribution, ethnic variation, and histopathological characteristics[1]. There are approximately 129,000 newly diagnosed nasopharyngeal carcinoma and 73,000 patients die of this neoplasm worldwide in 2018[2]. According to the WHO criteria, keratinizing squamous cell carcinoma is defined as type I, whereas types II and III refer to non-keratinizing differentiated and undifferentiated carcinomas, respectively. In regions where nasopharyngeal carcinoma is endemic, e.g. South-Eastern Asia and North Africa, non-keratinizing carcinomas comprise almost 95% of cases, which are invariably associated with Epstein-Barr virus (EBV) infection[3]. Due to the anatomic location and high radiosensitivity, radiotherapy (RT) is the primary and only curative treatment for nasopharyngeal carcinoma. Meanwhile chemotherapy and targeted therapy also serve as pivotal advancement in the treatment of the locally advanced nasopharyngeal carcinoma[4-6]. However, the long-term prognosis remains relatively poor as the current therapeutic regimen...

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Intratumoural heterogeneity measured using FDG PET and MRI is associated with tumour–stroma ratio and clinical outcome in head and neck squamous cell carcinoma

Cited by 27 publications

References 34 publications

Addition of the tumour–stroma ratio to the 8th edition American Joint Committee on Cancer staging system improves survival prediction for patients with oral tongue squamous cell carcinoma

Addition of the tumour–stroma ratio to the 8th edition American Joint Committee on Cancer staging system improves survival prediction for patients with oral tongue squamous cell carcinoma

Establishment and validation of a nomogram with intratumoral heterogeneity derived from 18F-FDG PET/CT for predicting individual conditional risk of 5-year recurrence before initial treatment of nasopharyngeal carcinoma

Establishment and Validation of a Nomogram with Intratumoral Heterogeneity Derived from 18F-FDG PET/CT for Predicting Individual Conditional Risk of 5-Year Recurrence before Initial Treatment of Nasopharyngeal Carcinoma

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