title: The role of 18F-FDG PET/CT metabolic tumour volume in predicting survival in patients with metastatic nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To investigate the role of PET-derived imaging markers in predicting metastatic nasopharyngeal carcinoma (NPC) outcomes.
  
  
  METHODS
  A total of 56 patients with metastatic NPC were enrolled. Before treatment, all of the participants underwent (18)F-FDG PET/CT. The following (18)F-FDG PET parameters were assessed: standardised uptake value, metabolic tumour volume (MTV), and total lesion glycolysis. Multivariate Cox proportional hazards models were used to identify the independent predictors of survival.
  
  
  RESULTS
  The multivariate analysis showed that performance status>1 (P=0.007), Epstein-Barr virus (EBV) DNA titre>5000 copies/mL (P=0.001), and MTV>110 mL (P=0.013) were independent risk factors for progression-free survival (PFS). Male sex (P=0.004), performance status>1 (P<0.0001), EBV DNA level>5000 copies/mL (P<0.0001), and MTV>110 mL (P=0.003) independently predicted overall survival (OS). The 2-year PFS and OS rates of the patients with MTV≤110 mL were 23.2% and 43%, respectively, compared with 0% and 9.1%, respectively, for those with MTV>110 mL. Combining the MTV with the EBV DNA titre allowed further survival stratification by dividing the patients into three groups with distinct PFS (2-year rates=30.8%, 7.1%, and 0%, P<0.0001) and OS (2-year rates=68.4%, 40%, and 0%, P<0.0001) rates.
  
  
  CONCLUSIONS
  The MTV appears to be an independent risk factor in metastatic NPC patients. This factor is complementary to the EBV DNA titre for predicting survival in metastatic NPC.
authors.affiliation: Department of Nuclear Medicine, Chang Gung Memorial Hospital, Keelong, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Sheng-Chieh
authors.initials: SC
authors.lastname: Chan
authors.forename: Cheng-Lung
authors.initials: CL
authors.lastname: Hsu
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000473:pathology / Q000556:secondary* / Q000821:virology; D017024:Chemotherapy, Adjuvant; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D005544:Forecasting; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000821:virology; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18