Textural features of pretreatment 18F-FDG PET/CT images: Prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma

Nai Ming Cheng, Yu Hua Dean Fang, Joseph Tung Chieh Chang, Chung Guei Huang, Din Li Tsan, Shu Hang Ng, Hung Ming Wang, Chien Yu Lin, Chun Ta Liao, Tzu Chen Yen

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Abstract

Previous studies have shown that total lesion glycolysis (TLG) may serve as a prognostic indicator in oropharyngeal squamous cell carcinoma (OPSCC). We sought to investigate whether the textural features of pretreatment 18F-FDG PET/CT images can provide any additional prognostic information over TLG and clinical staging in patients with advanced T-stage OPSCC. Methods: We retrospectively analyzed the pretreatment 18F-FDG PET/CT images of 70 patients with advanced T-stage OPSCC who had completed concurrent chemoradiotherapy, bioradiotherapy, or radiotherapy with curative intent. All of the patients had data on human papillomavirus (HPV) infection and were followed up for at least 24 mo or until death. A standardized uptake value (SUV) of 2.5 was taken as a cutoff for tumor boundary. The textural features of pretreatment 18F-FDG PET/CT images were extracted from histogram analysis (SUV variance and SUV entropy), normalized gray-level cooccurrence matrix (uniformity, entropy, dissimilarity, contrast, homogeneity, inverse different moment, and correlation), and neighborhood gray-tone difference matrix (coarseness, contrast, busyness, complexity, and strength). Receiver-operating-characteristic curves were used to identify the optimal cutoff values for the textural features and TLG. Results: Thirteen patients were HPV-positive. Multivariate Cox regression analysis showed that age, tumor TLG, and uniformity were independently associated with progression-free survival (PFS) and disease-specific survival (DSS). TLG, uniformity, and HPV positivity were significantly associated with overall survival (OS). A prognostic scoring system based on TLG and uniformity was derived. Patients who presented with TLG > 121.9 γ and uniformity ≤ 0.138 experienced significantly worse PFS, DSS, and OS rates than those without (P < 0.001, < 0.001, and 0.002, respectively). Patients with TLG > 121.9 γ or uniformity ≤ 0.138 were further divided according to age, and different PFS and DSS were observed. Conclusion: Uniformity extracted from the normalized gray-level cooccurrence matrix represents an independent prognostic predictor in patients with advanced T-stage OPSCC. A scoring system was developed and may serve as a risk-stratification strategy for guiding therapy. Key Words: oropharyngeal carcinoma; HPV; FDG PET/CT; total lesion glycolysis; textural analysis. COPYRIGHT

Original languageEnglish
Pages (from-to)1703-1709
Number of pages7
JournalJournal of Nuclear Medicine
Volume54
Issue number10
DOIs
Publication statusPublished - 2013 Oct 1

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Fluorodeoxyglucose F18
Glycolysis
Squamous Cell Carcinoma
Disease-Free Survival
Survival
Entropy
Papillomavirus Infections
Chemoradiotherapy
ROC Curve
Neoplasms
Radiotherapy
Survival Rate
Regression Analysis
Carcinoma

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Cheng, Nai Ming ; Fang, Yu Hua Dean ; Chang, Joseph Tung Chieh ; Huang, Chung Guei ; Tsan, Din Li ; Ng, Shu Hang ; Wang, Hung Ming ; Lin, Chien Yu ; Liao, Chun Ta ; Yen, Tzu Chen. / Textural features of pretreatment 18F-FDG PET/CT images : Prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma. In: Journal of Nuclear Medicine. 2013 ; Vol. 54, No. 10. pp. 1703-1709.
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title = "Textural features of pretreatment 18F-FDG PET/CT images: Prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma",
abstract = "Previous studies have shown that total lesion glycolysis (TLG) may serve as a prognostic indicator in oropharyngeal squamous cell carcinoma (OPSCC). We sought to investigate whether the textural features of pretreatment 18F-FDG PET/CT images can provide any additional prognostic information over TLG and clinical staging in patients with advanced T-stage OPSCC. Methods: We retrospectively analyzed the pretreatment 18F-FDG PET/CT images of 70 patients with advanced T-stage OPSCC who had completed concurrent chemoradiotherapy, bioradiotherapy, or radiotherapy with curative intent. All of the patients had data on human papillomavirus (HPV) infection and were followed up for at least 24 mo or until death. A standardized uptake value (SUV) of 2.5 was taken as a cutoff for tumor boundary. The textural features of pretreatment 18F-FDG PET/CT images were extracted from histogram analysis (SUV variance and SUV entropy), normalized gray-level cooccurrence matrix (uniformity, entropy, dissimilarity, contrast, homogeneity, inverse different moment, and correlation), and neighborhood gray-tone difference matrix (coarseness, contrast, busyness, complexity, and strength). Receiver-operating-characteristic curves were used to identify the optimal cutoff values for the textural features and TLG. Results: Thirteen patients were HPV-positive. Multivariate Cox regression analysis showed that age, tumor TLG, and uniformity were independently associated with progression-free survival (PFS) and disease-specific survival (DSS). TLG, uniformity, and HPV positivity were significantly associated with overall survival (OS). A prognostic scoring system based on TLG and uniformity was derived. Patients who presented with TLG > 121.9 γ and uniformity ≤ 0.138 experienced significantly worse PFS, DSS, and OS rates than those without (P < 0.001, < 0.001, and 0.002, respectively). Patients with TLG > 121.9 γ or uniformity ≤ 0.138 were further divided according to age, and different PFS and DSS were observed. Conclusion: Uniformity extracted from the normalized gray-level cooccurrence matrix represents an independent prognostic predictor in patients with advanced T-stage OPSCC. A scoring system was developed and may serve as a risk-stratification strategy for guiding therapy. Key Words: oropharyngeal carcinoma; HPV; FDG PET/CT; total lesion glycolysis; textural analysis. COPYRIGHT",
author = "Cheng, {Nai Ming} and Fang, {Yu Hua Dean} and Chang, {Joseph Tung Chieh} and Huang, {Chung Guei} and Tsan, {Din Li} and Ng, {Shu Hang} and Wang, {Hung Ming} and Lin, {Chien Yu} and Liao, {Chun Ta} and Yen, {Tzu Chen}",
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Textural features of pretreatment 18F-FDG PET/CT images : Prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma. / Cheng, Nai Ming; Fang, Yu Hua Dean; Chang, Joseph Tung Chieh; Huang, Chung Guei; Tsan, Din Li; Ng, Shu Hang; Wang, Hung Ming; Lin, Chien Yu; Liao, Chun Ta; Yen, Tzu Chen.

In: Journal of Nuclear Medicine, Vol. 54, No. 10, 01.10.2013, p. 1703-1709.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Textural features of pretreatment 18F-FDG PET/CT images

T2 - Prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma

AU - Cheng, Nai Ming

AU - Fang, Yu Hua Dean

AU - Chang, Joseph Tung Chieh

AU - Huang, Chung Guei

AU - Tsan, Din Li

AU - Ng, Shu Hang

AU - Wang, Hung Ming

AU - Lin, Chien Yu

AU - Liao, Chun Ta

AU - Yen, Tzu Chen

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Previous studies have shown that total lesion glycolysis (TLG) may serve as a prognostic indicator in oropharyngeal squamous cell carcinoma (OPSCC). We sought to investigate whether the textural features of pretreatment 18F-FDG PET/CT images can provide any additional prognostic information over TLG and clinical staging in patients with advanced T-stage OPSCC. Methods: We retrospectively analyzed the pretreatment 18F-FDG PET/CT images of 70 patients with advanced T-stage OPSCC who had completed concurrent chemoradiotherapy, bioradiotherapy, or radiotherapy with curative intent. All of the patients had data on human papillomavirus (HPV) infection and were followed up for at least 24 mo or until death. A standardized uptake value (SUV) of 2.5 was taken as a cutoff for tumor boundary. The textural features of pretreatment 18F-FDG PET/CT images were extracted from histogram analysis (SUV variance and SUV entropy), normalized gray-level cooccurrence matrix (uniformity, entropy, dissimilarity, contrast, homogeneity, inverse different moment, and correlation), and neighborhood gray-tone difference matrix (coarseness, contrast, busyness, complexity, and strength). Receiver-operating-characteristic curves were used to identify the optimal cutoff values for the textural features and TLG. Results: Thirteen patients were HPV-positive. Multivariate Cox regression analysis showed that age, tumor TLG, and uniformity were independently associated with progression-free survival (PFS) and disease-specific survival (DSS). TLG, uniformity, and HPV positivity were significantly associated with overall survival (OS). A prognostic scoring system based on TLG and uniformity was derived. Patients who presented with TLG > 121.9 γ and uniformity ≤ 0.138 experienced significantly worse PFS, DSS, and OS rates than those without (P < 0.001, < 0.001, and 0.002, respectively). Patients with TLG > 121.9 γ or uniformity ≤ 0.138 were further divided according to age, and different PFS and DSS were observed. Conclusion: Uniformity extracted from the normalized gray-level cooccurrence matrix represents an independent prognostic predictor in patients with advanced T-stage OPSCC. A scoring system was developed and may serve as a risk-stratification strategy for guiding therapy. Key Words: oropharyngeal carcinoma; HPV; FDG PET/CT; total lesion glycolysis; textural analysis. COPYRIGHT

AB - Previous studies have shown that total lesion glycolysis (TLG) may serve as a prognostic indicator in oropharyngeal squamous cell carcinoma (OPSCC). We sought to investigate whether the textural features of pretreatment 18F-FDG PET/CT images can provide any additional prognostic information over TLG and clinical staging in patients with advanced T-stage OPSCC. Methods: We retrospectively analyzed the pretreatment 18F-FDG PET/CT images of 70 patients with advanced T-stage OPSCC who had completed concurrent chemoradiotherapy, bioradiotherapy, or radiotherapy with curative intent. All of the patients had data on human papillomavirus (HPV) infection and were followed up for at least 24 mo or until death. A standardized uptake value (SUV) of 2.5 was taken as a cutoff for tumor boundary. The textural features of pretreatment 18F-FDG PET/CT images were extracted from histogram analysis (SUV variance and SUV entropy), normalized gray-level cooccurrence matrix (uniformity, entropy, dissimilarity, contrast, homogeneity, inverse different moment, and correlation), and neighborhood gray-tone difference matrix (coarseness, contrast, busyness, complexity, and strength). Receiver-operating-characteristic curves were used to identify the optimal cutoff values for the textural features and TLG. Results: Thirteen patients were HPV-positive. Multivariate Cox regression analysis showed that age, tumor TLG, and uniformity were independently associated with progression-free survival (PFS) and disease-specific survival (DSS). TLG, uniformity, and HPV positivity were significantly associated with overall survival (OS). A prognostic scoring system based on TLG and uniformity was derived. Patients who presented with TLG > 121.9 γ and uniformity ≤ 0.138 experienced significantly worse PFS, DSS, and OS rates than those without (P < 0.001, < 0.001, and 0.002, respectively). Patients with TLG > 121.9 γ or uniformity ≤ 0.138 were further divided according to age, and different PFS and DSS were observed. Conclusion: Uniformity extracted from the normalized gray-level cooccurrence matrix represents an independent prognostic predictor in patients with advanced T-stage OPSCC. A scoring system was developed and may serve as a risk-stratification strategy for guiding therapy. Key Words: oropharyngeal carcinoma; HPV; FDG PET/CT; total lesion glycolysis; textural analysis. COPYRIGHT

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