Prognostic value of pretreatment 18F-FDG PET/CT and human papillomavirus type 16 testing in locally advanced oropharyngeal squamous cell carcinoma

  • Nai-Ming Cheng
  • Joseph Tung-Chieh Chang
  • Chung-Guei Huang
  • Din-Li Tsan
  • Shu-Hang Ng
  • Hung-Ming Wang
  • Chun-Ta Liao
  • Chien-Yu Lin
  • Cheng-Lung Hsu
  • Tzu-Chen Yen
Original Article

DOI: 10.1007/s00259-012-2186-9

Cite this article as:
Cheng, NM., Chang, J.TC., Huang, CG. et al. Eur J Nucl Med Mol Imaging (2012) 39: 1673. doi:10.1007/s00259-012-2186-9

Abstract

Purpose

Human papillomavirus type 16 (HPV-16) positivity is associated with favourable survival in oropharyngeal squamous cell carcinoma (OPSCC). We report here a study of the prognostic significance of 18F-FDG PET/CT functional parameters and HPV-16 infection in OPSCC patients.

Methods

We retrospectively analysed 60 patients with stage III or IV OPSCC who had had a pretherapy 18F-FDG PET/CT scan and had completed concurrent chemoradiotherapy (n = 58) or curative radiotherapy (n = 2). All patients were followed up for ≥24 months or until death. We determined total lesion glycolysis (TLG) and the maximal standardized uptake values (SUVmax) of the primary tumour and neck lymph nodes from the pretherapy 18F-FDG PET/CT scan. Optimal cut-offs of the 18F-FDG PET/CT parameters were obtained by receiver operating characteristic (ROC) curve analyses. Pretherapy tumour biopsies were studied by polymerase chain reaction to determine HPV infection status.

Results

The pretherapy tumour biopsies were positive for HPV-16 in 12 patients (20.0 %). Cox regression analyses revealed HPV-16 positivity and tumour TLG >135.3 g to be independently associated with overall survival (p = 0.027 and 0.011, respectively). However, only tumour TLG >135.3 g was independently associated with progression-free survival, disease-free survival and locoregional control (p = 0.011, 0.001 and 0.034, respectively). A scoring system was formulated to define distinct overall survival groups using tumour TLG and HPV-16 status. Patients positive for HPV-16 and with tumour TLG ≤135.3 g experienced better survival than those with tumour TLG >135.3 g and no HPV infection (p = 0.001).

Conclusion

Tumour TLG was an independent predictor of survival in patients with locally advanced OPSCC. A scoring system was developed and may serve as a risk stratification strategy for guiding therapy.

Keywords

Oropharyngeal carcinomaHPVFDGPET/CTTotal lesion glycolysisStandardized uptake valueHead and neckPrognosis

Supplementary material

259_2012_2186_MOESM1_ESM.doc (34 kb)
Supplementary table 1Cutoffs of PET parameters (DOC 34 kb)

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Nai-Ming Cheng
    • 1
  • Joseph Tung-Chieh Chang
    • 2
  • Chung-Guei Huang
    • 3
  • Din-Li Tsan
    • 2
  • Shu-Hang Ng
    • 4
  • Hung-Ming Wang
    • 5
  • Chun-Ta Liao
    • 6
  • Chien-Yu Lin
    • 2
  • Cheng-Lung Hsu
    • 5
  • Tzu-Chen Yen
    • 1
  1. 1.Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
  2. 2.Department of Radiation Oncology, Chang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
  3. 3.Department of Laboratory MedicineChang Gung Memorial Hospital and Chang Gung University College of MedicineTaipeiTaiwan
  4. 4.Department of Diagnostic Radiology, Chang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
  5. 5.Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan
  6. 6.Department of Otolaryngology–Head & Neck Surgery, Chang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwan