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Increased evidence for the prognostic value of primary tumor asphericity in pretherapeutic FDG PET for risk stratification in patients with head and neck cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In a previous study, we demonstrated the first evidence that the asphericity (ASP) of pretherapeutic FDG uptake in the primary tumor provides independent prognostic information in patients with head and neck cancer. The aim of this work was to confirm these results in an independent patient group examined at a different site.

Methods

FDG-PET/CT was performed in 37 patients. The primary tumor was delineated by an automatic algorithm based on adaptive thresholding. For the resulting ROIs, the metabolically active part of the tumor (MTV), SUVmax, SUVmean, total lesion glycolysis (TLG) and ASP were computed. Univariate Cox regression with respect to progression free survival (PFS) and overall survival (OS) was performed. For survival analysis, patients were divided in groups of high and low risk according to the parameter cut-offs defined in our previous work. In a second step, the cut-offs were adjusted to the present data. Univariate and multivariate Cox regression was performed for the pooled data consisting of the current and the previously described patient group (N = 68). In multivariate Cox regression, clinically relevant parameters were included.

Results

Univariate Cox regression using the previously published cut-off values revealed TLG (hazard ratio (HR) = 3) and ASP (HR = 3) as significant predictors for PFS. For OS MTV (HR = 2.7) and ASP (HR = 5.9) were significant predictors. Using the adjusted cutoffs MTV (HR = 2.9/3.3), TLG (HR = 3.1/3.3) and ASP (HR = 3.1/5.9) were prognostic for PFS/OS. In the pooled data, multivariate Cox regression revealed a significant prognostic value with respect to PFS/OS for MTV (HR = 2.3/2.1), SUVmax (HR = 2.1/2.5), TLG (HR = 3.5/3.6), and ASP (HR = 3.4/4.4).

Conclusions

Our results confirm the independent prognostic value of ASP of the pretherapeutic FDG uptake in the primary tumor in patients with head and neck cancer. Moreover, these results demonstrate that ASP can be determined unambiguously across different sites.

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Acknowledgments

This work was supported in parts by the German Federal Ministry of Education and Research (BMBF contract 03ZIK42/OncoRay).

Conflict of interests

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany

    Frank Hofheinz, Alexandr Lougovski, Jörg Kotzerke & Jörg van den Hoff

  2. Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Klaus Zöphel, Maria Hentschel, Jörg Kotzerke & Jörg van den Hoff

  3. Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Ingo G. Steffen, Florian Wedel, Ralph Buchert & Winfried Brenner

  4. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany

    Ivayla Apostolova

  5. Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Michael Baumann

  6. OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany

    Michael Baumann

  7. Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany

    Michael Baumann

Authors
  1. Frank Hofheinz
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  2. Alexandr Lougovski
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  3. Klaus Zöphel
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  4. Maria Hentschel
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  5. Ingo G. Steffen
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  6. Ivayla Apostolova
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  7. Florian Wedel
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  8. Ralph Buchert
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  9. Michael Baumann
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  10. Winfried Brenner
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  11. Jörg Kotzerke
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  12. Jörg van den Hoff
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Corresponding author

Correspondence to Frank Hofheinz.

Additional information

F. Hofheinz and A. Lougovski contributed equally to this article.

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Hofheinz, F., Lougovski, A., Zöphel, K. et al. Increased evidence for the prognostic value of primary tumor asphericity in pretherapeutic FDG PET for risk stratification in patients with head and neck cancer. Eur J Nucl Med Mol Imaging 42, 429–437 (2015). https://doi.org/10.1007/s00259-014-2953-x

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  • DOI: https://doi.org/10.1007/s00259-014-2953-x

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