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Establishment and validation of a nomogram with intratumoral heterogeneity derived from 18F-FDG PET/CT for predicting individual conditional risk of 5-year recurrence before initial treatment of nasopharyngeal carcinoma

  • Gu, Bingxin1, 2, 3, 4
  • Zhang, Jianping1, 2, 3, 4, 5, 5
  • Ma, Guang1, 2, 3, 4
  • Song, Shaoli1, 2, 3, 4
  • Shi, Liqun5, 5
  • Zhang, Yingjian1, 2, 3, 4
  • Yang, Zhongyi1, 2, 3, 4
  • 1 Fudan University Shanghai Cancer Center, No. 270, Dong’an Road, Shanghai, Xuhui District, 200032, China , Shanghai (China)
  • 2 Shanghai Medical College, Fudan University, Shanghai, 200032, China , Shanghai (China)
  • 3 Fudan University, Shanghai, 200032, China , Shanghai (China)
  • 4 Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China , Shanghai (China)
  • 5 Fudan University, Shanghai, 200433, China , Shanghai (China)
Published Article
BMC Cancer
Springer (Biomed Central Ltd.)
Publication Date
Jan 15, 2020
DOI: 10.1186/s12885-020-6520-5
Springer Nature


BackgroundIntratumoral heterogeneity has an enormous effect on patient treatment and outcome. The purpose of the current study was to establish and validate a nomogram with intratumoral heterogeneity derived from 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prognosis of 5-Year progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC).MethodsA total of 171 NPC patients who underwent pretreatment 18F-FDG PET/CT were retrospectively enrolled. Data was randomly divided into training cohort (n = 101) and validation cohort (n = 70). The clinicopathologic parameters and the following PET parameters were analyzed: maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI, SUVmax/SUVmean) for primary tumor and maximal neck lymph node. Cox analyses were performed on PFS in the training cohort. A prognostic nomogram based on this model was developed and validated.ResultsFor the primary tumor, MTV-2.5, TLG-2.5, MTV-70%, and TLG-70% were significantly correlated with PFS. For the maximal neck lymph node, short diameter and HI were significantly correlated with PFS. Among the clinicopathologic parameters, M stage was a significant prognostic factor for recurrence. In multivariate analysis, M stage (P = 0.006), TLG-T-70% (P = 0.002), and HI-N (P = 0.018) were independent predictors. Based on this prognostic model, a nomogram was generated. The C-index of this model was 0.74 (95% CI: 0.63–0.85). For the cross validation, the C-index for the model was 0.73 (95% CI: 0.62–0.83) with the validation cohort. Patients with a risk score of ≥111 had poorer survival outcomes than those with a risk score of 0–76 and 77–110.ConclusionsIntratumoral heterogeneity derived from 18F-FDG PET/CT could predict long-term outcome in patients with primary NPC. A combination of PET parameters and the TNM stage enables better stratification of patients into subgroups with different PFS rates.

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