Development and validation of radiologic scores for guiding individualized induction chemotherapy in T3N1M0 nasopharyngeal carcinoma

Shan-Shan Yang, Yi-Shan Wu, Ya-Jun Pang, Su-Ming Xiao, Bao-Yu Zhang, Zhi-Qiao Liu, En-Ni Chen, Xu Zhang, Pu-Yun OuYang, Fang-Yun Xie, Shan-Shan Yang, Yi-Shan Wu, Ya-Jun Pang, Su-Ming Xiao, Bao-Yu Zhang, Zhi-Qiao Liu, En-Ni Chen, Xu Zhang, Pu-Yun OuYang, Fang-Yun Xie

Abstract

Objectives: We aimed to develop and validate radiologic scores from [18F]FDG PET/CT and MRI to guide individualized induction chemotherapy (IC) for patients with T3N1M0 nasopharyngeal carcinoma (NPC).

Methods: A total of 542 T3N1M0 patients who underwent pretreatment [18F]FDG PET/CT and MRI were enrolled in the training cohort. A total of 174 patients underwent biopsy of one or more cervical lymph nodes. Failure-free survival (FFS) was the primary endpoint. The radiologic score, which was calculated according to the number of risk factors from the multivariate model, was used for risk stratification. The survival difference of patients undergoing concurrent chemoradiotherapy (CCRT) with or without IC was then compared in risk-stratified subgroups. Another cohort from our prospective clinical trial (N = 353, NCT03003182) was applied for validation.

Results: The sensitivity of [18F]FDG PET/CT was better than that of MRI (97.7% vs. 87.1%, p < 0.001) for diagnosing histologically proven metastatic cervical lymph nodes. Radiologic lymph node characteristics were independent risk factors for FFS (all p < 0.05). High-risk patients (n = 329) stratified by radiologic score benefited from IC (5-year FFS: IC + CCRT 83.5% vs. CCRT 70.5%; p = 0.0044), while low-risk patients (n = 213) did not. These results were verified again in the validation cohort.

Conclusions: T3N1M0 patients were accurately staged by both [18F]FDG PET/CT and MRI. The radiologic score can correctly identify high-risk patients who can gain additional survival benefit from IC and it can be used to guide individualized treatment of T3N1M0 NPC.

Key points: • [18F]FDG PET/CT was more accurate than MRI in diagnosing histologically proven cervical lymph nodes. • Radiologic lymph node characteristics were reliable independent risk factors for FFS in T3N1M0 nasopharyngeal carcinoma patients. • High-risk patients identified by the radiologic score based on [18F]FDG PET/CT and MRI could benefit from the addition of induction chemotherapy.

Keywords: Induction chemotherapy; MRI; Nasopharyngeal carcinoma; [18F]FDG PET/CT.

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The flowchart of the included patients. CCRT, concurrent chemoradiotherapy; IC, induction chemotherapy; MRI, magnetic resonance imaging; NPC, nasopharyngeal carcinoma; [18F]FDG PET/CT, 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography
Fig. 2
Fig. 2
Survival curves of high- and low-risk groups stratified by radiologic score in FFS (a), DMFS (b), RRFS (c), and OS (d) in the training cohort. High-risk group: radiologic score > 0, low-risk group: radiologic score = 0. DMFS, distant metastasis-free survival; FFS, failure-free survival; OS, overall survival; RRFS, regional relapse-free survival
Fig. 3
Fig. 3
Kaplan–Meier FFS curves of IC + CCRT and CCRT alone in the training cohort (whole cohort (a), low-risk group (b), high-risk group (c)) and validation cohort (whole cohort (d), low-risk group (e), high-risk group (f)). CCRT, concurrent chemoradiotherapy; FFS, failure-free survival; IC, induction chemotherapy

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