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Zone-size nonuniformity of 18F-FDG PET regional textural features predicts survival in patients with oropharyngeal cancer

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

Abstract

Purpose

The question as to whether the regional textural features extracted from PET images predict prognosis in oropharyngeal squamous cell carcinoma (OPSCC) remains open. In this study, we investigated the prognostic impact of regional heterogeneity in patients with T3/T4 OPSCC.

Methods

We retrospectively reviewed the records of 88 patients with T3 or T4 OPSCC who had completed primary therapy. Progression-free survival (PFS) and disease-specific survival (DSS) were the main outcome measures. In an exploratory analysis, a standardized uptake value of 2.5 (SUV 2.5) was taken as the cut-off value for the detection of tumour boundaries. A fixed threshold at 42 % of the maximum SUV (SUVmax 42 %) and an adaptive threshold method were then used for validation. Regional textural features were extracted from pretreatment 18F-FDG PET/CT images using the grey-level run length encoding method and grey-level size zone matrix. The prognostic significance of PET textural features was examined using receiver operating characteristic (ROC) curves and Cox regression analysis.

Results

Zone-size nonuniformity (ZSNU) was identified as an independent predictor of PFS and DSS. Its prognostic impact was confirmed using both the SUVmax 42 % and the adaptive threshold segmentation methods. Based on (1) total lesion glycolysis, (2) uniformity (a local scale texture parameter), and (3) ZSNU, we devised a prognostic stratification system that allowed the identification of four distinct risk groups. The model combining the three prognostic parameters showed a higher predictive value than each variable alone.

Conclusion

ZSNU is an independent predictor of outcome in patients with advanced T-stage OPSCC, and may improve their prognostic stratification.

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Conflicts of interest

None.

Financial support

This study was supported by the grant NMRPG102-2221-E-182-074-MY2 from the National Science Council, Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Departments of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taiyuan, Taiwan

    Nai-Ming Cheng & Tzu-Chen Yen

  2. Department of Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan

    Nai-Ming Cheng

  3. Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan

    Nai-Ming Cheng & Ching-Han Hsu

  4. Department of Electrical Engineering, Chang Gung University, Taiyuan, Taiwan

    Yu-Hua Dean Fang

  5. Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Li-yu Lee

  6. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Joseph Tung-Chieh Chang & Din-Li Tsan

  7. Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Shu-Hang Ng

  8. Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Hung-Ming Wang

  9. Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Chun-Ta Liao

  10. Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Lan-Yan Yang

  11. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan

    Tzu-Chen Yen

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  1. Nai-Ming Cheng
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  9. Lan-Yan Yang
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  11. Tzu-Chen Yen
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Corresponding author

Correspondence to Tzu-Chen Yen.

Additional information

Ching-Han Hsu and Tzu-Chen Yen contributed equally to this work.

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Cheng, NM., Fang, YH.D., Lee, Ly. et al. Zone-size nonuniformity of 18F-FDG PET regional textural features predicts survival in patients with oropharyngeal cancer. Eur J Nucl Med Mol Imaging 42, 419–428 (2015). https://doi.org/10.1007/s00259-014-2933-1

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  • DOI: https://doi.org/10.1007/s00259-014-2933-1

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