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. 2023 Feb 1;48(2):126-131.
doi: 10.1097/RLU.0000000000004483. Epub 2022 Dec 7.

Impact of Neck PET/CT Positivity on Survival Outcomes-Visual and Quantitative Assessment: Results From ACRIN 6685

Brendan C Stack Jr  1 , Fenghai Duan, Justin Romanoff  2 , JoRean D Sicks  2 , Rathan M Subramaniam, Val J Lowe  3
Affiliations

Impact of Neck PET/CT Positivity on Survival Outcomes-Visual and Quantitative Assessment: Results From ACRIN 6685

Brendan C Stack Jr et al. Clin Nucl Med. .

Abstract

Introduction: FDG PET/CT was prospectively studied in 287 cN0 head and neck cancer patients in ACRIN 6685, and additional analysis of neck FDG uptake upon recurrence-free survival (RFS) and overall survival (OS) was performed.

Patients and methods: Two hundred eight had analyzable data. Survival analysis was performed to compare RFS and OS based on neck FDG visual assessment (VA) and SUV max . For SUV max , the optimal thresholds were calculated using conditional inference trees on a randomly selected 70% training data set and validated using the remaining 30% of data. Kaplan-Meier curves with log-rank tests were generated for the patient groups based on VA and optimal SUV max thresholds, and the hazards ratios (HRs) and 95% confidence intervals (CIs) were also calculated. Hypothesis testing was set at a significance level of 0.05.

Results: A total of 73.9% of bilateral cN0 and 50.0% of unilateral cN0 were alive at the end of the study with the remaining being dead or lost to follow-up. Overall survival median follow-up time was 24.0 months (interquartile range, 15.8-25.3; range, 0-37.0). A total of 63.3% of bilateral cN0 and 42.5% of unilateral cN0 patients remained disease free during the study. Recurrence-free survival median follow-up time was 23.9 months (interquartile range, 12.4-25.2; range, 0-35.6). Visual assessment of necks by our panel of radiologists was significantly associated with RFS (HR [95% CI], 2.30 [1.10-4.79]; P = 0.02), but not with OS (HR [95% CI], 1.64 [0.86-3.14]; P = 0.13). The optimal SUV max thresholds were 2.5 for RFS and 5.0 for OS. For SUV max assessment, applying the optimal thresholds to the 30% test data yielded HRs (95% CIs) of 2.09 (0.61-7.14; P = 0.23) for RFS and 3.42 (1.03-11.41; P = 0.03) for OS. The SUV max threshold of 5.0 was significantly associated with RFS (HR [95% CI], 5.92 [1.79-19.57]; P < 0.001).

Conclusions: Neck FDG uptake by VA is significant for RFS. An SUV max threshold of 5.0 is significantly associated with OS and RFS.

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Conflict of interest statement

Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This study was supported by the National Cancer Institute through grants no.U01 CA079778, U01 CA080098, CA180820, and CA180794. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.

Figures

Figure 1 –
Figure 1 –
Kaplan-Meier curves for recurrence-free survival (RFS), stratified by FDG-PET/CT visual assessment result. Two years of follow-up. P-value from the log-rank test: P=0.02.
Figure 2 –
Figure 2 –
Kaplan-Meier curves for recurrence-free survival (RFS), stratified by FDG-PET/CT visual assessment result, for (A) both sides cN0 and (B) one side cN0. Two years of follow-up. P-values from the log-rank test: (A) P=0.02, (B) P=0.54.
Figure 2 –
Figure 2 –
Kaplan-Meier curves for recurrence-free survival (RFS), stratified by FDG-PET/CT visual assessment result, for (A) both sides cN0 and (B) one side cN0. Two years of follow-up. P-values from the log-rank test: (A) P=0.02, (B) P=0.54.
Figure 3 –
Figure 3 –
Kaplan-Meier curves for overall survival (OS), stratified by FDG-PET/CT visual assessment result. Two years of follow-up. P-value from the log-rank test: P=0.13.
Figure 4 –
Figure 4 –
Kaplan-Meier curves for the optimal SUVmax thresholds. RFS (A), the hazard ratio (95% CI) is 3.42 (1.03, 11.41); the log-rank test P-value is P=0.03. OS (B), the hazard ratio (95% CI) is 2.09 (0.61, 7.14); the log-rank test P-value is P=0.23.
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