Impact of (18)F-FDG PET/CT staging on management and prognostic stratification in head and neck squamous cell carcinoma: A prospective observational study.
Accurate assessment of the extent of cancer is essential for appropriate treatment planning and outcome prediction. This study prospectively evaluated whether adding (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) to the routine initial staging practice in head and neck squamous cell carcinoma (HNSCC) improved management and prognosis.



All consecutive patients with newly diagnosed HNSCC who presented in October 2010 - December 2012 underwent conventional workups (CWU) followed by PET/CT. The clinical stage and management plans before and after PET/CT were compared. PET/CT was deemed to have no/low, moderate, and high impact on management planning depending on whether PET/CT changed the treatment modality or goal. The appropriateness of PET/CT staging and management impact was confirmed by histopathology and clinical follow-up, and its association with survival was analysed.



Of the 248 patients, PET/CT changed the Tumour Node Metastasis (TNM) classification in 79 (31.9%). In the patients with discordant staging, PET/CT staging was significantly more sensitive and accurate than CWU staging (both P < 0.001). PET/CT had high or moderate impact on management in 39 (15.7%) patients. Patients with PET/CT upstaged disease had significantly worse progression-free survival (PFS) and overall survival (OS) than patients with no CWU-stage changes (3-year PFS = 56.8% versus 74.5%, P = 0.043; 3-year OS = 61.3% versus 85.3%, P = 0.006). Multivariate analyses revealed that PET/CT staging and second primary cancer were independent predictive factors for both PFS and OS (P < 0.05, each).



(18)F-FDG PET/CT added important staging information that improved management and prognostic stratification in HNSCC.
Department of Otolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
In Sun
IS
Ryu
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: rohjl@amc.seoul.kr.
Jong-Lyel
JL
Roh
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Jae Seung
JS
Kim
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Jeong Hyun
JH
Lee
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Kyung-Ja
KJ
Cho
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Seung-Ho
SH
Choi
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Soon Yuhl
SY
Nam
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sang Yoon
SY
Kim
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000145:classification / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D000077195:Squamous Cell Carcinoma of Head and Neck
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
(18)F-FDG PET/CT; Head and neck squamous cell carcinoma; Management; Prognosis; Staging