A PET/CT-based strategy is a stronger predictor of survival than a standard imaging strategy in patients with head and neck squamous cell carcinoma

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Purpose: To examine whether tumor staging by upfront (18)F-fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) leads to improved discrimination of survival, when compared with traditionally used imaging strategies based on chest X-ray + head and neck magnetic resonance imaging (CXR/MRI) or chest computed tomography + head and neck MRI (CCT/MRI) in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Blinded prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited at Odense University Hospital from September 2013 to March 2016. All included patients underwent CXR/MRI, CCT/MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I-II), locally advanced (stages III-IVB), or metastatic (stage IVC) disease. Discriminative abilities for each imaging modality with respect to HNSCC staging were compared using Kaplan-Meier analysis, Cox proportional-hazards regression with Harrell's C-index, and net reclassification improvement (NRI). Results: A total of 307 patients with histologically verified HNSCC were included. Use of PET/CT resulted in significantly altered stratification of tumor stage, when compared to either CXR/MRI or CCT/MRI (χ(2): P < 0.001 for both). Cancer stages based on PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk in Kaplan-Meier analyses (P ≤ 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/CT (C-index: 0.712) than CXR/MRI (C-index: 0.675, P = 0.04 for difference) and CCT/MRI (C-index: 0.657, P = 0.02 for difference). Finally, PET/CT was significantly associated with a positive NRI when compared with CXR/MRI (0.184, P = 0.03), but not CCT/MRI (0.094%, P = 0.31). Conclusion: Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies.

TidsskriftJournal of Nuclear Medicine
Sidetal (fra-til)575-581
StatusUdgivet - 2018