Prospective Study of Tailoring Whole-Body Dual-Modality [18F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography With Plasma Epstein-Barr Virus DNA for Detecting Distant Metastasis in Endemic Nasopharyngeal Carcinoma at Initial Staging

Author:

Tang Lin-Quan1,Chen Qiu-Yan1,Fan Wei1,Liu Huai1,Zhang Lu1,Guo Ling1,Luo Dong-Hua1,Huang Pei-Yu1,Zhang Xu1,Lin Xiao-Ping1,Mo Yun-Xian1,Liu Li-Zhi1,Mo Hao-Yuan1,Li Jian1,Zou Ru-Hai1,Cao Yun1,Xiang Yan-Qun1,Qiu Fang1,Sun Rui1,Chen Ming-Yuan1,Hua Yi-Jun1,Lv Xing1,Wang Lin1,Zhao Chong1,Guo Xiang1,Cao Ka-Jia1,Qian Chao-Nan1,Zeng Mu-Sheng1,Mai Hai-Qiang1

Affiliation:

1. From the State Key Laboratory of Oncology in South China and Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.

Abstract

Purpose To evaluate which patients with nasopharyngeal carcinoma (NPC) obtained the greatest benefits from the detection of distant metastasis with [18F]fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) combined with plasma Epstein-Barr virus (EBV) DNA levels. Patients and Methods Consecutive patients with NPC were prospectively enrolled. PET/CT, conventional work-up (CWU), and quantification of plasma EBV DNA were performed before treatment. The accuracy of these strategies for distant metastases was assessed. The costs of the diagnostic strategies were compared. Results Eighty-six (14.8%) of the 583 eligible patients were found to have distant metastases; 71 patients (82.6%) by PET/CT and 31 patients (36.0%) by CWU. In the multivariable analysis, advanced N stage (odds ratio, 2.689; 95% CI, 1.894 to 3.818) and pretreatment EBV DNA level (odds ratio, 3.344; 95% CI, 1.825 to 6.126) were significant risk factors for distant metastases. PET/CT was not superior to CWU for detecting distant metastases in very low–risk patients (N0-1 with EBV DNA < 4,000 copies/mL; P = .062), but was superior for the low-risk patients (N0-1 with EBV DNA ≥ 4,000 copies/mL and N2-3 with EBV DNA < 4,000 copies/mL; P = .039) and intermediate-risk patients (N2-3 disease with EBV DNA ≥ 4,000 copies/mL; P < .001). The corresponding patient management changes based on PET/CT were 2.9%, 6.3%, and 16.5%, respectively. The costs per true-positive case detected by PET/CT among these groups were ¥324,138 (≈$47,458), ¥96,907 (≈$14,188), and ¥34,182 (≈$5,005), respectively. Conclusion PET/CT detects more distant metastases than conventional staging in patients with NPC. The largest benefit in terms of cost and patient management was observed in the subgroup with N2-3 disease and EBV DNA ≥ 4,000 copies/mL.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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