Prognostic Significance of ¹⁸F-FDG PET Parameters and Plasma Epstein-Barr Virus DNA Load in Patients with Nasopharyngeal Carcinoma

Abstract

The plasma concentration of Epstein-Barr virus (EBV) DNA is associated with tumor burden and prognosis in patients with nasopharyngeal carcinoma (NPC), but data on the relationship between viral load and 18 F-FDG PET functional parameters are lacking. We examined the association of 18 F-FDG PET functional parameters and EBV DNA load with the clinicopathologic characteristics and clinical outcomes of patients with NPC. Methods: One hundred eight patients with NPC who underwent 18 F-FDG PET before treatment were included in this study. We determined total lesion glycolysis (TLG) of the primary tumor, the cervical nodes, and their combination and the maximal standardized uptake value of the primary tumor and cervical lymph nodes. EBV DNA was measured by real-time polymerase chain reaction. Results: EBV DNA was significantly associated with total TLG (R 2 5 0.589). Total TLG values had the highest correlation with EBV DNA load and were significantly associated with tumor, nodal, and overall stages. However, tumor TLG greater than the median (.65 g) was the only parameter significantly associated with overall, local recurrence-free, disease-free, and distant metastasis-free survivals (P 5 0.033, 0.014, ,0.001, and 0.023, respectively). After allowance for potential confounders, tumor TLG retained its independent significance for overall and disease-free survival rates (P 5 0.045 and 0.006, respectively). Conclusion: Total TLG values are primarily associated with tumor burden and clinical stage, whereas tumor TLG is the best predictor of patient survival after treatment.

Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy

“…All these studies showed that MTV/TLG were predictive for clinical outcome, with a higher predictive value than SUVmax. In (Chang et al, 2012), 108 patients with nasopharyngeal cancer treated with RT-CT were prospectively included to assess the predictive value of SUVMax, MTV and TLG for DFS and OS. Only Epstein-Barr virus DNA load and TLG of the tumor were significantly correlated with DFS and OS.…”

Textural Features of Pretreatment 18F-FDG PET/CT Images: Prognostic Significance in Patients with Advanced T-Stage Oropharyngeal Squamous Cell Carcinoma

“…The boundaries were drawn to include the primary tumor within the oropharynx on the axial 18 F-FDG PET/CT images. The lesions were automatically contoured at a threshold standardized uptake value (SUV) of 2.5 (7,23), and the voxels presenting an SUV intensity . 2.5 within the contouring margin were incorporated to define the MTV.…”

Prognostic role of plasma Epstein-Barr virus DNA load for nasopharyngeal carcinoma: a meta-analysis

“…The meta-analysis found that high pre-treatment levels of EBV DNA had good value as a prognostic indicator of survival and disease outcomes in patients with NPC. Most of the studies included in this meta-analysis found that increased levels of EBV DNA prior to treatment was associated with poor overall survival [13,[28][29][30][32][33][34][35][36][37]39,40]. Of the studies that evaluated the other outcomes, high pre-treatment EBV DNA levels was also associated with increased risk for disease progression, relapse, recurrence, and distant metastasis.…”

“…The remaining 57 were fully evaluated for inclusion and 41 were eliminated for not reporting the outcomes of interest, reporting data that could not be pooled for a meta-analysis, not being relevant or reporting findings from a study that was already included. Sixteen studies were included in the study with a total of 7698 patients [12,13,[28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Three of the studies were retrospective in design and the remaining 13 studies were prospective (Table 1).…”