Prediction of disease-free survival in patients with squamous cell carcinomas of the head and neck using dynamic contrast-enhanced MR imaging

Abstract

Background and purpose: Patients with HNSCC have a poor prognosis and development of imaging biomarkers that predict long-term outcome might aid in planning optimal treatment strategies. Therefore, the purpose of the present study was to predict disease-free survival in patients with HNSCC by using pretreatment K(trans) measured from dynamic contrast-enhanced MR imaging.

Materials and methods: Sixty-six patients with HNSCC were recruited from January 2005 to October 2008. Three patients were excluded because they underwent upfront neck dissection, and 6 patients were excluded due to suboptimal MR imaging data or being lost to follow-up. Disease-free survival was measured in the remaining 57 patients from the end date of chemoradiation therapy. In patients who died, the end point was the date of death, while in surviving patients the date of last clinical follow-up was used as the end point. Pretreatment K(trans) and nodal volume were computed from the largest metastatic node, and median pretreatment K(trans) and volume were used to divide patients into 2 groups (at or above the threshold value [group I] and below the threshold value [group II]. Disease-free survival was analyzed by the Kaplan-Meier method, and the results were compared by using a logrank test with K(trans) and nodal volume as predictors. A P value <.05 was considered significant.

Results: Thirteen of 57 patients had died of HNSCC by the last follow-up period (March 31, 2009). Patients with higher pretreatment K(trans) values had prolonged disease-free survival compared with patients with lower K(trans) values (P=.029). However, there was no significant difference in disease-free survival when nodal volume was used as a predictor (P=.599).

Conclusions: Pretreatment K(trans) may be a useful prognostic marker in HNSCC.

Fig 1.

Representative images from a patient with HNSCC before chemoradiation therapy. A, Axial T2-weighted image demonstrates a heterogeneous hyperintense metastatic lymph node at level IIa of the right neck (arrow). B, This mass exhibits heterogeneous enhancement on a contrast-enhanced T1-weighted image. C, DCE-MRI−derived K^trans map is shown as a color image overlaid on a postcontrast T1-weighted image.

Fig 2.

Patients with higher pretreatment K^trans values (solid line) demonstrate significantly prolonged disease-free survival compared with patients with lower K^trans values (dashed line, P = .029). Patients with lower pretreatment nodal volume demonstrate better disease-free survival (dashed line) in comparison with patients with higher nodal volume (solid-line); however, the difference is not significant (P = .599). The x-axis shows the follow-up duration in months.