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Nuklearmedizin 2018; 57(05): 190-197
DOI: 10.3413/Nukmed-0965-18-03
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Prognostic Value of Pre-treatment F-18 FDG PET Metabolic Metrics in Patients with Locally Advanced Carcinoma of the Anus with and without HIV Infection

Prognostischer Wert der F-18 FDG PET metabolischen Aktivität vor Therapie des lokal fortgeschrittenen Anal-Plattenepithelkarzinoms bei HIV-positiven und -negativen Patienten
Ismaheel O. Lawal
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
,
Alfred O Ankrah
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
2   Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen & University of Groningen, Groningen, The Netherlands
,
Kgomotso M.G. Mokoala
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
,
Gbenga O. Popoola
3   Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria
,
Chimbabantu A Kaoma
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
,
Alex Maes
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
4   Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
,
Neo P. Mokgoro
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
,
Christophe Van de Wiele
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
5   Department of Radiology and Nuclear Medicine, University Ghent, Ghent, Belgium
,
Mike M. Sathekge
1   Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
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Publikationsverlauf

received: 17. März 2018

accepted: 25. Juni 2018

Publikationsdatum:
28. September 2018 (online)

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Summary

Aim: To investigate the prognostic value of F-18 FDG PET metabolic parameters in patients with anal carcinoma with and without human immunodeficiency virus infection (HIV). Methods: Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were obtained on F-18 FDG PET/CT images of treatment-naïve patients with locally advanced anal squamous cell carcinoma (ASSC). We compared patients’ characteristics and F-18 FDG PET metabolic metrics between the HIV-infected patients and the HIV-uninfected patients. We did a simple Cox regression analysis followed by a multiple Cox regression analysis to determine factors predictive of death. Results: We studied 33 patients including 21 HIV-infected individuals, mean age = 46.06 ± 12.59, female = 16, males = 17. Median CD4 count among HIV-infected patients was 400.50 cells/mm3 (IQR: 304.0 – 642.25). HIV-infected patients were younger than the HIV-uninfected patients at the time of diagnosis; 38.71 ± 7.98 vs. 58.92 ± 7.88 respectively, p < 0.001. No significant difference in the TNM stage and F-18 FDG metabolic parameters between the two groups. In a simple Cox regression analysis, MTV and TLG were significant predictors of death. Following a multiple Cox regression analysis, MTV and SUVmean were significant predictors of death. The median overall survival was 44.63 (95 % CI: 34.12 – 55.14) among HIV-infected patients versus 54.65 (95 % CI: 45.73 – 63.57) among HIV-uninfected patients, p = 0.415. Conclusion: HIV-infected patients are diagnosed with ASSC at a younger age compared with HIV-uninfected patients. F-18 FDG PET metabolic metrics especially MTV predicts overall survival in patients with ASCC. There is no difference in the overall survival of HIV-infected and HIV-uninfected patients treated similarly for ASSC.

Zusammenfassung

Ziel: Die Untersuchung der prognostischen Bedeutung der F-18 FDG PET metabolischen Aktivität bei HIV-negativen und positiven Analkarzinom-Patienten. Methoden: Bestimmt wurden maximale standardisierten Uptake-Werte (SUVmax), mittlere standardisierte Uptake-Werte (SUVmean), das metabolische Tumorvolumen (MTV) sowie die gesamte Tumorlyse-Glukose (TLG) mittels F-18 FDG PET/CT bei behandlungsnaiven Patienten mit lokal fortgeschrittenem Anal-Plattenepithelkarzinom (ASSC). Die Patientencharakteristika und F-18 FDG PET metabolischen Ergebnisse der HIV-positiven und HIV-negativen Patienten wurden verglichen. Eine einfache Cox-Regressionsanalyse gefolgt von einer multiplen Cox-Regressionsanalyse diente der Bestimmung von Faktoren für Tod.

Ergebnisse: Wir untersuchten 33 Patienten, davon 21 HIV-Infizierte, mittleres Alter = 46,06 ± 12,59, Frauen = 16, Männer = 17. Die mediane CD4-Zahl unter den HIV-Patienten war 400,50 Zellen/mm3 (IRQ: 304,0 – 642,25). Die HIV-infizierten Patienten waren jünger als die HIV-negativen Patienten zum Zeitpunkt der Diagnose; 38,71 ± 7,98 vs. 58,92 ± 7,88, p < 0,001. Es gab keinen signifikanten Unterschied in der TNM-Klassifikation und in den F-18 FDG metabolischen Werten zwischen den beiden Gruppen. In einer einfachen Cox-Regressionsanalyse waren MTV und TLG signifikante Prädiktoren für Tod. Das mediane Gersamtüberleben lag bei 44,63 (95 % CI: 34,12 – 55,14) unter den HIV-infizierten Patienten vs. 54,65 (95 % CI: 45,73 – 63,57) unter den HIV-negativen Patienten, p = 0,415.

Schlussfolgerungen: HIV-infizierte Patienten werden in jüngeren Jahren mit ASSC diagnostiziert im Vergleich zu HIV-negativen Patienten. F-18 FDG PET metabolische Aktivität, insbesondere MTV, kann das Gesamtüberleben von Patienten mit ASCC vorhersagen. Es gibt keinen Unterschied im Gesamtüberleben von HIV-infizierten und HIV-negativen Patienten bei gleicher Therapie des ASSC.

Keywords

F-18 FDG PET - SUVmax - MTV - TLG - HIV - carcinoma of the anus

Schlüsselwörter

F-18 FDG PET - SUVmax - MTV - TLG - HIV - Analkarzinom
 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2018. CA Cancer J Clin 2018; 68: 7-30.
    CrossrefPubMedSuche in Google Scholar
  • 2 Combes JD, Heard I, Poizot-Martin I. et al. Prevalence and risk factors for anal human papillomavirus infection in HIV-positive men having sex with men. J Infect Dis. Epub ahead of print on Jan 31, 2018 doi: 10.1093/infdis/jiy059.
    PubMedSuche in Google Scholar
  • 3 Rovelli C, Poli A, Galli L. et al. Presence of multiple genotypes in subjects with HPV-16 infection is highly associated with anal squamous intraepithelial lesions in HIV-1 infected males. PLoS One 2017; 12: e0186367 doi: 10.1371/journal.pone.0186367.
    CrossrefPubMedSuche in Google Scholar
  • 4 Mahale P, Engels EA, Coghill AE, Kahn AR, Shiels MS. Cancer Risk in Older Persons Living With Human Immunodeficiency Virus Infection in the United States. Clin Infect Dis. 2018 Epub ahead of print. doi: 10.1093/cid/ciy012.
    PubMedSuche in Google Scholar
  • 5 Oehler-Janne C, Seifert B, Lutolf UM. et al. Local tumor control and toxicity in HIV-associated anal carcinoma treated with radiotherapy in the era of antiretroviral therapy. Radiat Oncol 2006; 01: 29.
    CrossrefPubMedSuche in Google Scholar
  • 6 Grew D, Bitterman D, Leichman CG. et al. HIV Infection Is Associated With Poor Outcomes for Patients With Anal Cancer in the Highly Active Anti retroviral Therapy Era. Dis Colon Rectum 2015; 58: 1130-1136.
    CrossrefPubMedSuche in Google Scholar
  • 7 Pappou EP, Magruder JT, Fu T. et al. Prognostic and Predictive Clinicopathologic Factors of Squamous Anal Canal Cancer in HIV-Positive and HIV-Negative Patients: Does HAART Influence Outcomes?. World J Surg 2018; 42: 876-883.
    CrossrefPubMedSuche in Google Scholar
  • 8 Lokko C, Turner J, Yoo W. et al. Anal Squamous Cell Carcinoma in African Americans with and without HIV: A comparative Study. J Cancer Epidemiol Treat 2015; 01: 6-10.
    Suche in Google Scholar
  • 9 White EC, Khodayaris B, Erickson KT, Lien WW, Hwang-Graziano J, Rao AR. Comparison of Toxicity and Treatment Outcomes in HIV-positive Versus HIV-negative Patients With Squamous Cell Carcinoma of the Anal Canal. Am J Clin Oncol 2017; 40: 386-392.
    CrossrefPubMedSuche in Google Scholar
  • 10 Fraunholz I, Rabeneck D, Gerstein J. et al. Concurrent chemoradiotherapy with 5-fluorouracil and mitomycin C for anal carcinoma: are there differences between HIV-positive and HIV-negative parics on overall survival. The impact of these metabolic metrics on other treatment outcomes such as treatment-related toxicity, event-free survival, etc. were not evaluated for in our study. tients in the era of highly active antiretroviral therapy? Radiother Oncol 2011; 98: 99-104.
    Suche in Google Scholar
  • 11 Oehler-Jänne C, Huguet F, Provencher S. et al. HIV-specific Differences in Outcome of Squamous Cell Carcinoma of the Anal Canal: A Multicentric Cohort Study of HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy. J Clin Oncol 2008; 26: 2550-2557.
    CrossrefPubMedSuche in Google Scholar
  • 12 Lawal I, Lengana T, Ololade K. et al. 18F-FDG PET/ CT in the detection of asymptomatic malignant melanoma recurrence. Nukleamedizin 2017; 56: 83-89.
    Suche in Google Scholar
  • 13 Lee JY, Choi JY, Heo JH. et al. Prognostic significance of volume-based 18F-FDG PET/CT parameter in patients with surgically resected nonsmall cell lung cancer. Nukleamedizin 2016; 55: 7-14.
    Suche in Google Scholar
  • 14 An Y-S, Lee DH, Yoon J-K. et al. Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI. Nukleamedizine 2014; 53: 89-94.
    Suche in Google Scholar
  • 15 Jones M, Hruby G, Solomon M, Rutherford N, Martin J. The role of FDG-PET in the Initial Staging and Response Assessment of Anal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2015; 22: 3574-3581.
    CrossrefPubMedSuche in Google Scholar
  • 16 Liang Y, Li X, Wan H. et al. Prognostic Value of Volume-Based Metabolic Parameters Obtained by 18F-FDG-PET/CT in Patients With Locally Advanced Squamous Cell Cervical Carcinoma. J Comput Assist Tomogr. 2018 Epub ahead of print. doi: 10.1097/RCT.0000000000000708.
    PubMedSuche in Google Scholar
  • 17 Ngeow JYY, Quek RHH, Ng DCE. et al. High SUV uptake on FDG-PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG-PET/CT staging in lymphoma. Ann. Oncol 2009; 20: 1543-1547.
    CrossrefPubMedSuche in Google Scholar
  • 18 Van de Wiele C, Kruse V, Smeets P. et al. Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging 2013; 40: 290-301.
    CrossrefPubMedSuche in Google Scholar
  • 19 Lawal IO, Nyakale NE, Harry LM. et al. The role of F-18 FDG PET/CT in evaluating the impact of HIV infection on tumor burden and therapy outcome in patients with Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2017; 44: 2025-2033.
    CrossrefPubMedSuche in Google Scholar
  • 20 Wieland U, Hellmich M, Wetendorf J. et al. Smoking and anal high-risk human papillomavirus DNA loads in HIV-positive men who have sex with men. Int J Med Microbiol 2015; 305: 689-696.
    CrossrefPubMedSuche in Google Scholar
  • 21 Lin C, Franceschi S, Clifford GM. Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: a systematic review and meta-analysis. Lancet Infect Dis 2018; 18: 198-206.
    CrossrefPubMedSuche in Google Scholar
  • 22 Zhang H, Wrobblewski K, Liao S. et al. Prognostic value of metabolic tumor burden from(18)F-FDG PET in surgical patients with non-small-cell lung cancer. Acad Radiol 2013; 20: 32-40.
    CrossrefPubMedSuche in Google Scholar
  • 23 Huang Y, Feng M, He Q. et al. Prognostic value of pretreatment 18F-FDG PET-CT for nasopharyngeal carcinoma patients. Medicine (Baltimore) 2017; 96: e6721 doi: 10.1097/MD.0000000000006721.
    Suche in Google Scholar
  • 24 Hwang SH, Cho A, Yun M, Choi YD, Rha SY, Kang WJ. Prognostic Value of Pretreatment Metabolic Tumor Volume and Total Lesion Glycolysis Using 18F-FDG PET/CT in Patients With Metastatic Renal Cell Carcinoma Treated With Anti-Vascular Endothelial Growth Factor-Targeted Agents. Clin Nucl Med 2017; 42: e235-e241.
    CrossrefPubMedSuche in Google Scholar
  • 25 Bazan JG, Koong AC, Kapp DS. et al. Metabolic tumor volume predicts disease progression and survival in patients with squamous cell carcinoma of the anal canal. J Nucl Med 2013; 54: 27-32.
    CrossrefPubMedSuche in Google Scholar
  • 26 Cardenas ML, Spencer CR, Markovina S. et al. Quantitative FDG-PET/CT predicts local recurrence and survival for squamous cell carcinoma of the anus. Adv Radiat Oncol 2017; 02: 281-287.
    Suche in Google Scholar
  • 27 Kidd EA, Dehdashti F, Siegel BA, Grigsby PW. Anal cancer maximum F-18 fluorodeoxyglucose uptake on positron emission tomography is correlated with prognosis. Radiother Oncol 2010; 95: 288-291.
    CrossrefPubMedSuche in Google Scholar
  • 28 Montoto S, Shaw K, Okosun J. et al. HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era. J Clin Oncol 2012; 30: 4111-4116.
    CrossrefPubMedSuche in Google Scholar
  • 29 Besson C, Lancar R, Prevot S. et al. High Risk Features Contrast With Favorable Outcomes in HIVassociated Hodgkin Lymphoma in the Modern cART Era, ANRS CO16 LYMPHOVIR Cohort. Clin Infect Dis 2015; 61: 1469-1475.
    CrossrefPubMedSuche in Google Scholar
  • 30 Soriqué M, García O, Tapia G. et al. HIV-infection has no prognostic impact on advanced-staged Hodgkin Lymphoma. AIDS 2017; 31: 1445-1449.
    CrossrefPubMedSuche in Google Scholar