Combing MRI Perfusion and  18 F-FDG PET/CT Metabolic Biomarkers Helps Predict Survival in Advanced Nasopharyngeal Carcinoma: A Prospective Multimodal Imaging Study

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Abstract

Simple Summary

Among various types of head and neck cancers, nasopharyngeal carcinoma (NPC) has a distinct epidemiology and prognosis. Tumor recurrence in NPC poses significant clinical challenges and identifying novel prognostic biomarkers is crucial. Imaging biomarkers derived from positron emission tomography (PET) and magnetic resonance imaging (MRI) reflect different biological facets of tumors. However, whether pretreatment PET and MRI imaging biomarkers can complement each other in the survival prediction of NPC patients has not been determined. This prospective study aimed to analyze the prognostic value of imaging biomarkers derived from pretreatment MRI and PET in NPC. The model integrating the MRI perfusion markers with PET metabolic parameter demonstrated higher prognostic performance than the traditional staging system and individual model with either MRI or PET alone. A staging work-up for NPC including both functional MRI and PET parameters may provide clinicians with supplementary prognostic information in addition to morphologic assessment of tumor extent.

Abstract

We prospectively investigated the prognostic value of imaging parameters for nasopharyngeal carcinoma (NPC) using dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), and 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography ( ¹⁸F-FDG PET)/computed tomography (CT). Patients with stage III–IVb NPC underwent F-FDG PET/CT, DCE-MRI, and DWI before treatment. Kaplan-Meier and Cox-regression analyses were used to assess associations of PET and MRI imaging biomarkers with overall survival (OS) and recurrence-free survival (RFS). We used independent prognosticators to establish prognostic models; model performance was examined using Harrell’s concordance index (c-index). Sixty-one patients were available for analysis, as 13 patients died and 20 experienced recurrence. Total lesion glycolysis (TLG) ( p = 0.002) from PET/CT and the initial area under the curve (iAUC) ( p = 0.036) from DCE-MRI were identified as independent prognosticators of OS; Epstein-Barr virus (EBV) DNA ( p = 0.027), the extracellular volume fraction ( V _e ) ( p = 0.027) from DCE-MRI, and TLG/iAUC ( p = 0.025) were significant predictors of RFS. The c-indices of the prognostic models incorporating TLG + iAUC in predicting OS and incorporating EBV DNA + V _e + TLG/iAUC in predicting RFS were 0.79 and 0.76, respectively. These were significantly higher than the corresponding c-indices of the TNM staging system ( p = 0.047 and 0.025, respectively); they were also higher than those of models with only MRI or PET biomarkers. In conclusion, the combination of pretreatment DCE-MRI and ¹⁸F-FDG PET/CT imaging biomarkers helps survival prediction in advanced NPC. Integrating MRI perfusion with PET metabolism and plasma EBV information may aid clinicians in planning the optimal personalized management strategy.

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Author and article information

Contributors

Pierre Busson: Role: Academic Editor

Journal

Journal ID (nlm-ta): Cancers (Basel)

Journal ID (iso-abbrev): Cancers (Basel)

Journal ID (publisher-id): cancers

Title: Cancers

Publisher: MDPI

ISSN (Electronic): 2072-6694

Publication date (Electronic): 28 March 2021

Publication date Collection: April 2021

Volume: 13

Issue: 7

Electronic Location Identifier: 1550

Affiliations

[1 ]Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; wi110911@ 123456tzuchi.com.tw

[2 ]Department of Medicine, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan

[3 ]Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan; foliatus@ 123456cgmh.org.tw

[4 ]Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan; jtchang@ 123456cgmh.org.tw

[5 ]Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan; changkp@ 123456cgmh.org.tw

[6 ]Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; paulwang@ 123456tzuchi.com.tw

Author notes

[* ]Correspondence: shng@ 123456cgmh.org.tw ; Tel.: +886-3-3281200; Fax: +886-3-3281200-2620

Author information

Kai-Ping Chang https://orcid.org/0000-0003-1777-9578

Article

Publisher ID: cancers-13-01550

DOI: 10.3390/cancers13071550

PMC ID: 8036946

PubMed ID: 33800542

SO-VID: 336b903a-8609-4aa6-a5a5-339e21c6d25d

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).