Correlation between hematological parameters and PET/CT metabolic parameters in patients with head and neck cancer

Correlation of 18 F-FDG PET/CT metabolic parameters with Ki-67 expression and tumor staging in nasopharyngeal carcinoma

PURPOSE

The study aimed to investigate the imaging parameters of 18F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (PET/CT) in nasopharyngeal carcinoma (NPC), specifically examining the relationship between mean standardized uptake value (SUVmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) with Ki-67 expression, T-stage, and tumor node metastasis (TNM) stage.

METHODS

A retrospective analysis was conducted on 143 consecutive NPC patients from January 2015 to December 2023 who underwent 18 F-FDG PET/CT for initial disease assessment. SUVmax, SUVmean, MTV, and TLG were quantified from PET/CT images. Immunohistochemical staining was used to assess Ki-67 protein expression. Correlations between 18 F-FDG PET/CT metabolic parameters, Ki-67 expression, T-stage, and TNM-stage were evaluated using statistical methods, with significance set at P  < 0.05.

RESULTS

All primary NPC lesions demonstrated elevated 18 F-FDG uptake. Significant positive correlations were observed between SUVmax ( r  = 0.234, P  = 0.005), SUVmean ( r  = 0.223, P  = 0.007), MTV ( r  = 0.218, P  = 0.009), and TLG ( r  = 0.232, P  = 0.005) with Ki-67 labeling index. The univariate analysis indicated that all the parameters (SUVmax, SUVmean, MTV, and TLG) in the group with Ki-67 ≥ 50% were significantly higher than those in the group with Ki-67 < 50% ( P  = 0.001). Additionally, binary logistic regression analysis revealed that SUVmax was an independent risk factor for the group with Ki-67 ≥ 50% ( P  = 0.003). The univariate analysis revealed that all parameters (SUVmax, SUVmean, MTV, and TLG) in the T3-4 group and clinical stage IV group were significantly higher than those in the T1-2 group and stages I-III group ( P both <0.05), respectively. Furthermore, binary logistic regression analysis demonstrated that MTV was an independent risk factor for both comparisons ( P both <0.05).

CONCLUSION

The metabolic parameters derived from 18 F-FDG PET/CT in NPC indirectly reflect tumor biological behavior, suggesting their potential utility in guiding individualized comprehensive treatment strategies.

Relationship between muscular mass, inflammatory status, tumor metabolic activity and oral intake in head and neck cancer at the outset of management

BACKGROUND AND AIMS

Patients with head and neck cancer (HNC) are often malnourished with a low muscular mass at the outset of management. This is thought to be mainly due to poor nutritional intake. The aim of this study was to assess the correlation between tumor metabolic activity, inflammatory status and body composition in HNC patients.

MATERIALS AND METHODS

This retrospective study included 112 patients with HNC. Tumor metabolic activity was assessed using the total lesion glycolysis (TLG) and maximum standardized uptake value (SUVmax). Body composition was measured by the third cervical vertebra skeletal muscle index (C3 SMI). Systemic inflammation was measured by the modified Glasgow Prognostic Score (mGPS) and the neutrophil-to-lymphocyte ratio (NLR). Nutritional status was assessed by the Nutritional Risk Index (NRI).

RESULTS

The majority of patients had advanced tumor stage (75 %). Malnutrition was found in 39.3 % (NRI), and systemic inflammation in 44.7 % (mGPS) and 41.1 % (NLR) of patients. High TLG was associated. with low C3 SMI (p = 0.021), low NRI (p = 0.01), high mGPS (p = 0.001), and high NLR (p = 0.003). A high NLR was associated with a low C3 SMI (p = 0.046) and low body mass index (BMI) (p = 0.01).

CONCLUSION

Our study establishes a relationship between the high metabolic activity of tumor, the loss of muscle mass, and increased systemic inflammation.

Prognostic Value of the 18F-FDG PET/CT and Haematological Parameters in Head and Neck Cancer

INTRODUCTION

Fluorine 18-fluoro-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) is commonly used for the staging of head and neck cancer. This study aimed to evaluate the correlation between 18F-FDG PET/CT, haematological parameters and prognosis in patients with advanced head and neck cancer.

METHODS

This was a single-institutional retrospective study of 83 patients with advanced head and neck squamous cell carcinoma (HNSCC) who underwent 18F-FDG PET/CT imaging before initial treatment between 2014 and 2018. 18F-FDG PET/CT after treatment was performed in 57 patients. The prognostic parameters of the pre- and post-treatment maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV), total lesion glycolysis (TLG) of primary tumours and haematological parameters were analysed to evaluate the association between overall survival (OS) and progression-free survival (PFS).

RESULTS

Pre-MTV, pre-TLG and post-SUVmax were significantly associated with poor OS and PFS (p < 0.05). Haematological parameters, including pretreatment neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio, were associated with 18F-FDG PET/CT parameters. In multivariate analysis, post-SUVmax was an independent prognostic factor for OS and PFS.

CONCLUSION

A correlation between PET/CT metabolic and haematological parameters was observed. The volume and intensity of 18F-FDG uptake region, in addition to haematological parameters, are feasible markers for predicting the progression of HNSCC in daily practice. Further, post-SUVmax could be an independent parameter for predicting poor survival.

Recent nanotheranostic approaches in cancer research

Humanity is suffering from cancer which has become a root cause of untimely deaths of individuals around the globe in the recent past. Nanotheranostics integrates therapeutics and diagnostics to monitor treatment response and enhance drug efficacy and safety. We hereby propose to discuss all recent cancer imaging and diagnostic tools, the mechanism of targeting tumor cells, and current nanotheranostic platforms available for cancer. This review discusses various nanotheranostic agents and novel molecular imaging tools like MRI, CT, PET, SPEC, and PAT used for cancer diagnostics. Emphasis is given to gold nanoparticles, silica, liposomes, dendrimers, and metal-based agents. We also highlight the mechanism of targeting the tumor cells, and the limitations of different nanotheranostic agents in the field of research for cancer treatment. Due to the complexity in this area, multifunctional and hybrid nanoparticles functionalized with targeted moieties or anti-cancer drugs show the best feature for theranostics that enables them to work on carrying and delivering active materials to the desired area of the requirement for early detection and diagnosis. Non-invasive imaging techniques have a specificity of receptor binding and internalization processes of the nanosystems within the cancer cells. Nanotheranostics may provide the appropriate medicine at the appropriate dose to the appropriate patient at the appropriate time.

Prognostic value of haematological parameters and [18F]FDG PET/CT metabolic parameters in head and neck cancer

AIM

To determine the usefulness of neutrophil/lymphocyte (N/L) and platelet/lymphocyte (P/L) ratios as well as quantitative [18F]FDG PET/CT parameters as prognostic factors for overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) in patients with head and neck squamous cell carcinoma (HyN).

MATERIAL AND METHODS

Sixty-six patients (56 men) diagnosed with HyN carcinoma were retrospectively assessed over an 8-year interval. Maximum SUV (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) parameters were determined from the PET/CT study at diagnosis. After treatment with chemoradiotherapy, patient survival was assessed. The Cox regression model and the Kaplan-Meier method were used to analyse prognostic factors and survival curves.

RESULTS

Median follow-up was 50.4 months, with 39 recurrences-progressions and 39 deaths. In the univariate analysis, metabolic parameters, except SUVmax, were predictive factors for all three survivals and the two blood parameters were predictive for OS and EFS. TLG was the only predictive factor in the multivariate analysis. The three survival curves were significantly different for the metabolic parameters and the OS curve for the N/L ratio. Correlations were seen between N/L ratio, MTV and TLG. No correlations were demonstrated between P/L ratio and metabolic parameters.

CONCLUSION

The use of haematological and metabolic markers would allow to identify patients with a high risk of recurrences and por survival and to individualise treatment by applying more aggressive therapies.

Prognostic Value of Serum Neutrophil to Lymphocyte Ratio and SUVmax in Stage I and II Colon Cancer

OBJECTIVE

This study aimed to evaluate the correlation between maximal standardized uptake value (SUVmax) of primary colon cancer and serum neutrophil-to-lymphocyte ratio (NLR), and to assess the prognostic value of SUVmax and serum NLR in stage I and II colon cancer patients.

METHODS

In this retrospective study a total of 128 patients with pathologically confirmed stage I and II colon cancer diagnosed between January 2014 and December 2017 were included. All patients underwent F-18 Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and differential white blood cell (WBC) counts before surgery. The correlations between SUVmax and NLR were assessed. The prognostic value of SUVmax and NLR for predicting recurrence-free survival (RFS) was investigated.

RESULTS

The mean NLR was 2.2 ± 1.2, and the mean SUVmax of primary tumor was 15.2 ± 7.9. There was significant correlation between NLR and SUVmax (rho=0.2, p=0.02). Mean follow-up period was 59.8 ± 19.2 months and 12 patients experienced a recurrence. In univariable analysis, NLR (p=0.0084, HR=5.0223, 95% CI=1.5117-16.6853), C-reactive protein (CRP) (p=0.021, HR=4.1115, 95% CI=1.2380-13.6551), carbohydrate antigen 19-9 (CA19-9) (p=0.0134, HR=4.2683, 95% CI=1.3519-13.4766), and Kirsten ras sarcoma viral oncogene (KRAS) mutation (p=0.0338, HR=3.4703, 95% CI=1.0998-10.9499) were significant prognostic factors for the recurrence. In multivariable analysis, NLR (p=0.0256, HR=4.1155, 95% CI=1.1887-14.2490) and CA19-9 (p=0.0257, HR=4.139, 95% CI=1.1880-14.4200) were independent prognostic factors for the recurrence.

CONCLUSIONS

Significant correlation was observed between SUVmax of primary colon cancer and serum NLR. Furthermore, in the multivariable analysis conducted on early colon cancer cases, NLR and CA19-9 were found to be independently associated with RFS. This suggested that NLR could be used as a supplementary tool for identifying patients at high risk of recurrence in early colon cancer. However, SUVmax was not associated with prognosis, suggesting that it cannot be used for predicting prognosis in early colon cancer.