2017 Section 7 Green Book

I.S. Ryu et al. / European Journal of Cancer 63 (2016) 88 e 96

Fig. 2. Kaplan e Meier curves of progression-free survival (PFS) (A) and overall survival (OS) (B) according to the impact of PET/CT on the conventional workup-determined management plan of all patients. Patients with high impact had significantly worse PFS and OS than those with no/low impact (3-year PFS Z 28.6% versus 74.6%, P 0.001; 3-year OS Z 40% versus 85.7%, P < 0.001). However, patients with moderate impact did not significantly differ in terms of PFS or OS from patients with no/low impact.

Table 3 Factors affecting progression-free and overall survival outcomes in the study patients ( N Z 248). Variable Progression-free survival Overall survival

Univariate

Multivariate

Univariate

Multivariate

P a

P a

HR 95% CI

HR 95% CI

HR 95% CI

HR 95% CI

P

P

1.48 0.91 e 2.40 0.111 1.68 0.94 e 2.98 0.075 1.20 0.43 e 13.32 0.718

1.43 0.80 e 2.58 0.224 1.142 0.53 e 2.45 0.733 1.04 0.58 e 1.87 0.878 1.428 0.72 e 2.81 0.304

Age > 60 years

Sex, female

Smoking > 20 pack-year

Alcohol 1 drink per day 1.05 0.62 e 1.78 0.831

Tumour site

1.87 0.95 e 3.67 0.066

1.44 0.67 e 3.10 0.343 1.56 0.34 e 7.13 0.565

Non-oropharynx

Tumour differentiation, poor 1.30 0.73 e 2.32 0.366

Primary treatment b

0.73 0.43 e 1.21 0.226

0.93 0.51 e 1.70 0.826

Nonsurgical treatment

Conventional workup staging Nodal classification, N2 e 3 1.76 1.09 e 2.85

2.67 1.49 e 4.77 3.83 1.90 e 7.73

0.020 0.031

0.001

TNM stage, III e IV

1.71 1.04 e 2.59

< 0.001

PET/CT staging Nodal classification, N2 e 3 1.67 1.02 e 2.76

3.11 1.69 e 5.72 5.21 2.33 e 11.67 4.01 1.99 e 8.10

< 0.001 < 0.001 < 0.001

0.009 0.005 0.005

4.70 2.08 e 10.60 < 0.001

TNM stage, III e IV Second primary cancer

2.10 1.26 e 3.52 2.63 1.34 e 5.17

2.05 1.25 e 3.44 2.30 1.16 e 4.54

0.007 0.016

3.07 1.51 e 6.23

0.002

Abbreviations: CI, confidence interval; CT, computed tomography CRT, concurrent chemoradiation therapy; HR, hazard ratio; ICT, induction chemotherapy; PET, positron emission tomography; RT, radiotherapy. a In multivariate analysis, Cox proportional hazard regression analyses were performed with backward elimination using variables with P values < 0.05 on univariate analyses. Values in bold indicate P < 0.05. b The treatment modalities were divided into two major categories as follows: surgical treatment included surgery alone, surgery plus adjuvant RT or CRT, and ICT followed by definite surgery. Non-surgical treatment included definite CRT or RT and ICT followed by definite CRT with or without salvage surgery.

showed that initial PET/CT is important not only for staging and management planning but also for prog- nostic stratification. In conclusion, this large prospective study demon- strated that incorporating 18 F-FDG PET/CT in CWU staging provided valuable additional information that altered the management plan in 15.7% of patients,

largely because this modality detected metastatic disease or SPCs. PET/CT staging was significantly more pre- dictive of OS and PFS outcomes than CWU staging. Our findings suggest that the incorporation of PET/CT into routine clinical practice for the primary staging of HNSCC could aid the planning of treatment and the prediction of survival outcomes.

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