Prognostic value of 18F-FDG-PET/CT in patients with nasopharyngeal carcinoma: a systematic review and meta-analysis

Abstract

BackgroundThe prognostic role of 18F-fluorodeoxyglucose positron emission tomography CT (18F-FDG PET/CT) parameters is still controversial in nasopharyngeal carcinoma patients. We sought to perform a systematic review and meta-analysis to explore the prognostic value of maximal standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on event-free survival (EFS) and overall survival (OS) in nasopharyngeal carcinoma patients.ResultsFifteen studies comprising 1,938 patients were included in this study. The combined hazard ratios (HRs) for EFS were 2.63 (95%CI 1.71-4.05) for SUVmax, 2.55 (95%CI 1.49-4.35) for MTV, and 3.32 (95%CI 1.23-8.95) for TLG. The pooled HRs for OS were 2.07 (95%CI 1.54-2.79) for SUVmax, 3.86 (95%CI 1.85-8.06) for MTV, and 2.60 (95%CI 1.55-4.34) for TLG. The prognostic role of SUVmax, MTV and TLG remained similar in the sub-group analyses.MethodsA systematic literature search was performed to identify studies which associated 18F-FDG PET/CT to clinical survival outcomes of nasopharyngeal carcinoma patients. The summarized HRs for EFS and OS were estimated by using fixed- or random-effect models according to heterogeneity between trials.ConclusionsThe present meta-analysis confirms that high values of SUVmax, MTV and TLG predicted a higher risk of adverse events or death in patients with nasopharyngeal carcinoma, despite clinically heterogeneous nasopharyngeal carcinoma patients and the various methods adopted between these studies.

Cervical nodal volume for prognostication and risk stratification of patients with nasopharyngeal carcinoma, and implications on the TNM-staging system

“…A body of literature has found primary tumor parameters, volume and metabolic parameters such as SUV, MTV and total lesion glycolysis (TLG), to be prognostic, which is seemingly contradictory to our findings 6 , 21 , 22 . However, many of these studies did not include the analysis of nodal disease, and hence, their findings were not adjusted for nodal status.…”

Prognostic value of baseline [18F]-fluorodeoxyglucose positron emission tomography parameters MTV, TLG and asphericity in an international multicenter cohort of nasopharyngeal carcinoma patients

“…No PET parameters showed an association with FFDM. The results on the high prognostic impact of MTV are in line with two recent metaanalyses [4,5]. In contrast to our findings, a recent publication with 179 patients was able to show a correlation between the FDG-PET tumor parameter SUV max and FFDM [23].…”

Tumor Metabolic Features Identified by 18F-FDG PET Correlate with Gene Networks of Immune Cell Microenvironment in Head and Neck Cancer

“…Clinically, 18 F-FDG PET plays a great role in HNSCC because of its high accuracy for staging and its prognostic value (3). Several PET parameters such as maximum SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) have been used for prognostic quantitative markers (4)(5)(6).…”