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Asphericity of pretherapeutic tumour FDG uptake provides independent prognostic value in head-and-neck cancer

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Abstract

Objective

To propose a novel measure, namely the ‘asphericity’ (ASP), of spatial irregularity of FDG uptake in the primary tumour as a prognostic marker in head-and-neck cancer.

Methods

PET/CT was performed in 52 patients (first presentation, n = 36; recurrence, n = 16). The primary tumour was segmented based on thresholding at the volume-reproducible intensity threshold after subtraction of the local background. ASP was used to characterise the deviation of the tumour’s shape from sphere symmetry. Tumour stage, tumour localisation, lymph node metastases, distant metastases, SUVmax, SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were also considered. The association of overall (OAS) and progression-free survival (PFS) with these parameters was analysed.

Results

Cox regression revealed high SUVmax [hazard ratio (HR) = 4.4/7.4], MTV (HR = 4.6/5.7), TLG (HR = 4.8/8.9) and ASP (HR = 7.8/7.4) as significant predictors with respect to PFS/OAS in case of first tumour manifestation. The combination of high MTV and ASP showed very high HRs of 22.7 for PFS and 13.2 for OAS. In case of recurrence, MTV (HR = 3.7) and the combination of MTV/ASP (HR = 4.2) were significant predictors of PFS.

Conclusions

ASP of pretherapeutic FDG uptake in the primary tumour improves the prediction of tumour progression in head-and-neck cancer at first tumour presentation.

Key Points

•Asphericity (ASP) characterises the spatial heterogeneity of FDG uptake in tumours

• ASP is a promising prognostic parameter in head-and-neck cancer

• ASP is useful for identification of high-risk patients with head-and-neck cancer

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Abbreviations

ASP:

Asphericity

FWHM:

Full width at a half of maximum

HR:

Hazard ratio

HPV:

Human papilloma virus

MTV:

Metabolic tumour volume

OAS:

Overall survival

PFS:

Progression-free survival

ROI:

Region of interest

TLG:

Total lesion glycolysis

VOI:

Volume of interest

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Acknowledgments

The scientific guarantor of this publication is Prof. W. Brenner. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Two of the authors have significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Ivayla Apostolova and Ingo G. Steffen contributed equally.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Charité University Medical Center, Berlin, Germany

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

  2. Department of Radiooncology, Charité University Medical Center, Berlin, Germany

    Simone Marnitz

  3. Department of Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Thorsten Derlin

  4. Institute of Radiopharmaceutical Cancer Research, Helmholtz Center Dresden Rossendorf, Dresden, Germany

    Alexandr Lougovski & Frank Hofheinz

  5. Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Clinic Magdeburg, Leipziger Str. 44, 30120, Magdeburg, Germany

    Ivayla Apostolova, Ingo G. Steffen & Holger Amthauer

Authors
  1. Ivayla Apostolova
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  2. Ingo G. Steffen
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  3. Florian Wedel
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  10. Winfried Brenner
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Correspondence to Ivayla Apostolova.

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Apostolova, I., Steffen, I.G., Wedel, F. et al. Asphericity of pretherapeutic tumour FDG uptake provides independent prognostic value in head-and-neck cancer. Eur Radiol 24, 2077–2087 (2014). https://doi.org/10.1007/s00330-014-3269-8

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  • DOI: https://doi.org/10.1007/s00330-014-3269-8

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