Total lesion glycolysis on FDG-PET/CT before salvage surgery predicts survival in laryngeal or pharyngeal cancer

RadioFlow Cytometry Reveals That [18F]FDG Uptake in K-RAS Lung Cancer Is Driven by Immune Cells: An Analysis on a Single-Cell Level

Tumor metabolism is a hallmark of cancer, yet cellular heterogeneity within the tumor microenvironment presents a significant challenge, as bulk analysis masks the diverse metabolic profiles of individual cell populations. This complexity complicates our understanding of [18F]FDG uptake by distinct cell types in the tumor microenvironment. This study aims to investigate [18F]FDG uptake at the single-cell level in the lung of Kirsten rat sarcoma virus-driven cancer mouse models using the novel technique radio-flow cytometry (radioFlow). Methods: Two Kirsten rat sarcoma virus-driven lung cancer mouse models were injected with [18F]FDG for small-animal PET/CT and subsequent fluorescence-activated cell sorting of the lung. For radioFlow, the sorted cell fractions were then measured in a γ-counter and their radioactivity was normalized to the number of cells. Results: RadioFlow analysis of the lung tissue of both models showed a robust cell type-specific uptake pattern across experiments. Our key findings indicate that the [18F]FDG PET signal predominantly derives from immune cells (CD45+, F4/80-, 78.3% ± 6.6%; macrophage, 13.9% ± 4.3%), whereas tumor cells contributed only with 2.8% ± 1.0%, similar to the uptake of structural cells (CD45-; tumor cells, 5.0% ± 2.3%). Normalization showed that macrophages exhibited the highest glucose metabolism in both tumor models (57% ± 8%), followed by the remaining immune cells (27% ± 3%). Conclusion: These findings highlight the critical influence of immune cell metabolism on [18F]FDG imaging, emphasizing the need to account for immune contributions when interpreting [18F]FDG imaging in cancer.

Integration RNA bulk and single cell RNA sequencing to explore the change of glycolysis-related immune microenvironment and construct prognostic signature in head and neck squamous cell carcinoma

BACKGROUND

Glycolysis is an indispensable process for tumor cell,but the effect of glycolysis on the prognosis and immune cell infiltration of head and neck squamous cell carcinoma is not clear.

METHODS

Based on RNA bulk and single cell RNA sequencing data of head and neck squamous cell carcinoma from The Cancer Genome Atlas(TCGA) and GSE195832, the effect of glycolysis level on immune cell infiltration was analyzed. Then, we obtained the prognostic genes related to glycolysis through survival analysis to construct prognostic risk signature. Our sample and GSE65858 datasets are used as external verification datasets to verify the validity of the signature. Finally, we used Western blot and cell function assays to determine the relationship between risk genes and glycolysis and the function of prognostic genes.

RESULT

The level of glycolysis was related to the prognosis of head and neck tumors (P = 0.0044). The results of immune infiltration analysis of TCGA database showed that high level glycolysis subgroup had less infiltration of macrophages, T cells and monocytes. Results of single cell sequencing analysis validates the above results. Additionally, Five risk genes(MUCL1,TRIML2,RAB3B,SPINK6,IGSF11) were selected to construct signature.Risk score was an independent prognostic factor(P < 0.01). The external validation set also shows the same result. In vitro functional and Western blot assays confirmed that the above five genes affect tumor function and related to the process of glycolysis.

CONCLUSION

Glycolysis-related risk signatures can be used to predict the prognosis and immune infiltration of head and neck squamous cell carcinoma.

Pepsin enhances glycolysis to promote malignant transformation of vocal fold leukoplakia epithelial cells with dysplasia

PURPOSE

The mechanism underlying malignant transformation of vocal fold leukoplakia (VFL) and the precise role of the expression of pepsin in VFL remain unclear. This study aimed to investigate the effects of acidified pepsin on VFL epithelial cell growth and migration, and also identify pertinent molecular mechanisms.

METHODS

Immunochemistry and Western blotting were performed to measure glucose transporter type 1 (GLUT1), monocarboxylate transporters 4 (MCT4), and Hexokinase-II (HK-II) expressions. Cell viability, cell cycle, apoptosis, and migration were investigated by CCK-8 assay, flow cytometry and Transwell chamber assay, respectively. Glycolysis-related contents were determined using the corresponding kits. Mitochondrial HK-II was photographed under a confocal microscope using Mito-Tracker Red.

RESULTS

It was found: the expression of pepsin and proportion of pepsin+ cells in VFL increased with the increased dysplasia grade; acidified pepsin enhanced cell growth and migration capabilities of VFL epithelial cells, reduced mitochondrial respiratory chain complex I activity and oxidative phosphorylation, and enhanced aerobic glycolysis and GLUT1 expression in VFL epithelial cells; along with the transfection of GLUT1 overexpression plasmid, 18FFDG uptake, lactate secretion and growth and migration capabilities of VFL epithelial cell were increased; this effect was partially blocked by the glycolysis inhibitor 2-deoxy-glucose; acidified pepsin increased the expression of HK-II and enhanced its distribution in mitochondria of VFL epithelial cells.

CONCLUSION

It was concluded that acidified pepsin enhances VFL epithelial cell growth and migration abilities by reducing mitochondrial respiratory complex I activity and promoting metabolic reprogramming from oxidative phosphorylation to aerobic glycolysis.

Prognostic factors in salvage surgery for recurrent head and neck cancer: A systematic review and meta-analysis

INTRODUCTION

Although salvage surgery (SS) is considered the best curative choice in recurrent head and neck cancer, the identification of patients who can benefit the most from this treatment is challenging.

METHODS

We systematically reviewed the prognostic role of pre- and post-surgery factors in patients undergoing SS for recurrent head and neck cancer (oral cavity, oropharynx, hypopharynx, and larynx).

RESULTS

Twenty-five studies met the inclusion criteria out of 1280 screened citations. Pre-surgery factors significantly associated with worse overall survival were age>60 years, advanced initial stage, early recurrence, and regional recurrence; no heterogeneity between study emerged. Among post- surgery factors, worse survival emerged for positive surgical margins, extracapsular extension and perineural invasion.

CONCLUSION

The identification of pre-surgery factors associated with poor outcomes may help the selection of the best candidate to SS; alternative treatments should be considered for high-risk patients. Post-surgery predictors of worse prognosis may guide clinicians in tailoring patients' surveillance.

Prospect of positron emission tomography for abdominal aortic aneurysm risk stratification

Abdominal aortic aneurysm (AAA) disease is characterized by an asymptomatic, permanent, focal dilatation of the abdominal aorta progressing towards rupture, which confers significant mortality. Patient management and surgical decisions rely on aortic diameter measurements via abdominal ultrasound surveillance. However, AAA rupture can occur at small diameters or may never occur at large diameters, implying that anatomical size is not necessarily a sufficient indicator. Molecular imaging may help identify high-risk patients through AAA evaluation independent of aneurysm size, and there is the question of the potential role of positron emission tomography (PET) and emerging role of novel radiotracers for AAA. Therefore, this review summarizes PET studies conducted in the last 10 years and discusses the usefulness of PET radiotracers for AAA risk stratification. The most frequently reported radiotracer was [18F]fluorodeoxyglucose, indicating inflammatory activity and reflecting the biomechanical properties of AAA. Emerging radiotracers include [18F]-labeled sodium fluoride, a calcification marker, [64Cu]DOTA-ECL1i, an indicator of chemokine receptor type 2 expression, and [18F]fluorothymidine, a marker of cell proliferation. For novel radiotracers, preliminary trials in patients are warranted before their widespread clinical implementation. AAA rupture risk is challenging to evaluate; therefore, clinicians may benefit from PET-based risk assessment to guide patient management and surgical decisions.

18F-FDG-PET/CT in laryngeal cancer: Comparison with conventional imaging and prognostic role

OBJECTIVE

The aim of this study was to investigate the diagnostic accuracy of staging ¹⁸F-FDG-PET/CT in laryngeal cancer, compare these results with conventional imaging (CI) and assess the value of ¹⁸F-FDG-PET/CT features to predict survival.

METHODS

Fifty-four patients with laryngeal squamous cell cancer and baseline ¹⁸F-FDG-PET/CT were retrospectively enrolled. The PET images were analyzed visually and semi-quantitatively by measuring several metabolic parameters. A combination of clinical follow-up/imaging follow-up and/or histopathology was taken as reference standard. Progression free survival (PFS) and disease specific survival (DSS) were computed using Kaplan-Meier curves.

RESULTS

All primary tumors were clearly identified by CI, and 52/54 by ¹⁸F-FDG-PET/CT with a sensitivity of 96.3%. Cervical nodal metastases were detected in 40/54 patients at ¹⁸F-FDG-PET/CT and in 34/49 patients at CI. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy on a patient-based analysis for nodal disease were 100%, 85.7%, 94.6%, 100% and 95.9% at ¹⁸F-FDG-PET/CT, and 91.4%, 85.7%, 94.1%, 80%, 89.8% at CI. Diagnostic performances of PET/CT and CI were not significantly different on a patient-based, side-by-side and level-by-level analysis. ¹⁸F-FDG-PET/CT recognized distant metastases in 7 patients allowing to an upstaging. At a median follow-up of 27 months, relapse/progression of disease occurred in 31 patients and death occurred in 32. Metabolic tumor volume (MTV T), MTV total and total lesion glycolysis (TLG) showed to be independent prognostic factors for PFS.

CONCLUSIONS

Both CI and PET/CT had good diagnostic performances for the staging of laryngeal cancer; baseline metabolic features (MTV and TLG) showed an important prognostic value in assessing the rate of PFS.

Evaluation of the Prognostic Value of FDG PET/CT Parameters for Patients With Surgically Treated Head and Neck Cancer: A Systematic Review

Importance

Head and neck squamous cell cancer (HNSCC) represents the seventh most frequent cancer worldwide. More than half of the patients diagnosed with HNSCC are treated with primary surgery.

Objective

To report the available evidence on the value of quantitative parameters of fluorodeoxyglucose F 18-labeled positron emission tomography and computed tomography (FDG-PET/CT) performed before surgical treatment of HNSCC to estimate overall survival (OS), disease-free survival (DFS), and distant metastasis (DM) and to discuss their limitations.

Evidence Review

A systematic review of the English-language literature in PubMed/MEDLINE and ScienceDirect published between January 2003 and February 15, 2019, was performed between March 1 and July 27, 2019, to identify articles addressing the association between preoperative FDG-PET/CT parameters and oncological outcomes among patients with HNSCC. Articles included those that addressed the following: (1) cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) surgically treated (primary or for salvage); (3) pretreatment FDG-PET/CT; (4) quantitative or semiquantitative evaluation of the FDG-PET/CT parameters; and (5) the association between the value of FDG-PET/CT parameters and clinical outcomes. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine level of evidence.

Findings

A total of 128 studies were retrieved from the databases, and 36 studies met the inclusion criteria; these studies comprised 3585 unique patients with a median follow-up of 30.6 months (range, 16-53 months). Of these 36 studies, 32 showed an association between at least 1 FDG-PET/CT parameter and oncological outcomes (OS, DFS, and DM). The FDG-PET/CT volumetric parameters (metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) were independent prognostic factors in most of the data, with a higher prognostic value than the maximum standard uptake value (SUVmax). For example, in univariate analysis of OS, the SUVmax was correlated with OS in 5 of 11 studies, MTV in 11 of 12 studies, and TLG in 6 of 9 studies. The spatial distribution of metabolism via textural indices seemed promising, although that factor is currently poorly evaluated: only 3 studies analyzed data from radiomics indices.

Conclusions and Relevance

The findings of this study suggest that the prognostic effectiveness of FDG-PET/CT parameters as biomarkers of OS, DFS, and DM among patients with HNSCC treated with surgery may be valuable. The volumetric parameters (MTV and TLG) seemed relevant for identifying patients with a higher risk of postsurgical disease progression who could receive early therapeutic intervention to improve their prognosis. However, further large-scale studies including exclusively surgery-treated patients stratified according to localization and further analysis of the textural indices are required to define a reliable FDG-PET/CT-based prognostic model of mortality and recurrence risk for these patients.

Prediction of Response in Head and Neck Tumor: Focus on Main Hot Topics in Research

Radiation therapy is a cornerstone in the treatment of head and neck cancer patients; actually, their management is based on clinical and radiological staging with all patients at the same stage treated in the same way. Recently the increasing knowledge in molecular characterization of head and neck cancer opens the way for a more tailored treatment. Patient outcomes could be improved by a personalized radiotherapy beyond technological and anatomical precision. Several tumor markers are under evaluation to understand their possible prognostic or predictive value. In this paper we discuss those markers specific for evaluate response to radiation therapy in head and neck cancer for a shift toward a biological personalization of radiotherapy.

Targeting SKA3 suppresses the proliferation and chemoresistance of laryngeal squamous cell carcinoma via impairing PLK1-AKT axis-mediated glycolysis

Spindle and kinetochore-associated complex subunit 3 (SKA3) is a well-known regulator of chromosome separation and cell division, which plays an important role in cell proliferation. However, the mechanism of SKA3 regulating tumor proliferation via reprogramming metabolism is unknown. Here, SKA3 is identified as an oncogene in laryngeal squamous cell carcinoma (LSCC), and high levels of SKA3 are closely associated with malignant progression and poor prognosis. In vitro and in vivo experiments demonstrate that SKA3 promotes LSCC cell proliferation and chemoresistance through a novel role of reprogramming glycolytic metabolism. Further studies reveal the downstream mechanisms of SKA3, which can bind and stabilize polo-like kinase 1 (PLK1) protein via suppressing ubiquitin-mediated degradation. The accumulation of PLK1 activates AKT and thus upregulates glycolytic enzymes HK2, PFKFB3, and PDK1, resulting in enhancement of glycolysis. Furthermore, our data reveal that phosphorylation at Thr360 of SKA3 is critical for its binding to PLK1 and the increase in glycolysis. Collectively, the novel oncogenic signal axis "SKA3-PLK1-AKT" plays a critical role in the glycolysis of LSCC. SKA3 may serve as a prognostic biomarker and therapeutic target, providing a potential strategy for proliferation inhibition and chemosensitization in tumors, especially for LSCC patients with PLK1 inhibitor resistance.

18F-FDG-PET/CT in laryngeal cancer: comparison with conventional imaging and prognostic role

OBJECTIVE

The aim of this study was to investigate the diagnostic accuracy of staging 18 F-FDG-PET/CT in laryngeal cancer, compare these results with conventional imaging (CI) and assess the value of 18 F-FDG-PET/CT features to predict survival.

METHODS

Fifty-four patients with laryngeal squamous cell cancer and baseline 18 F-FDG-PET/CT were retrospectively enrolled. The PET images were analyzed visually and semi-quantitatively by measuring several metabolic parameters. A combination of clinical follow-up/imaging follow-up and/or histopathology was taken as reference standard. Progression free survival (PFS) and disease specific survival (DSS) were computed using Kaplan-Meier curves.

RESULTS

All primary tumors were clearly identified by CI, and 52/54 by 18 F-FDG-PET/CT with a sensitivity of 96.3%. Cervical nodal metastases were detected in 40/54 patients at 18 F-FDG-PET/CT and in 34/49 patients at CI. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy on a patient-based analysis for nodal disease were 100%, 85.7%, 94.6%, 100% and 95.9% at 18 F-FDG-PET/CT, and 91.4%, 85.7%, 94.1%, 80%, 89.8% at CI. Diagnostic performances of PET/CT and CI were not significantly different on a patient-based, side-by-side and level-by-level analysis. 18 F-FDG-PET/CT recognized distant metastases in 7 patients allowing to an upstaging. At a median follow-up of 27 months, relapse/progression of disease occurred in 31 patients and death occurred in 32. Metabolic tumor volume (MTV T), MTV total and total lesion glycolysis (TLG) showed to be independent prognostic factors for PFS.

CONCLUSIONS

Both CI and PET/CT had good diagnostic performances for the staging of laryngeal cancer; baseline metabolic features (MTV and TLG) showed an important prognostic value in assessing the rate of PFS.

Total Lesion Glycolysis Ratio in Positron Emission Tomography/Computed Tomography Images During Neoadjuvant Chemotherapy Can Predict Pathological Tumor Regression Grade and Prognosis in Patients with Locally Advanced Squamous Cell Carcinoma of the Esophagus

BACKGROUND

The usefulness of quantitating tumor lesion glycolysis (TLG) from ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings as a tool for determining the effect of neoadjuvant chemotherapy (NAC) in esophageal squamous cell carcinoma (ESCC) has not yet been established.

METHODS

The cohort of this retrospective study comprised 46 patients who had undergone NAC and subsequent esophagectomy for locally advanced ESCC between January 2008 and December 2017. PET/CT was conducted before and after NAC to assess its therapeutic effect. Associations between changes in TLG values during NAC and clinicopathological findings, pathological tumor regression grade (TRG), and prognosis were assessed.

RESULTS

Most patients received two courses of DCF (Docetaxel, Cisplatin, and Fluorouracil) as NAC. The mean TLG value of the primary tumor decreased significantly after NAC. The median follow-up period was 41 months. The Kaplan-Meier method, analyzed by log-rank test, showed that low TLG ratio (≤ 0.4) and low SUV_max ratio (≤ 0.6) were associated with favorable survival outcomes (P = 0.0073 and P = 0.032, respectively). Univariate and multivariate analysis revealed that TLG ratio and achievement of pathological cure were independent prognostic factors for overall survival. TLG ratio was also associated with pathological TRG (TRG 0-1a vs 1b-3) (P = 0.0016).

CONCLUSIONS

TLG ratio before and after NAC is clinically useful in predicting both histological response and survival outcome after NAC and subsequent esophagectomy in patients with ESCC.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer

INTRODUCTION

¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers.

OBJECTIVE

To investigate the prognostic value of these parameters in patients with head and neck cancers.

METHODS

We performed a retrospective study including 47 patients with head and neck cancer who underwent¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed.

RESULTS

The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm³ (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival.

CONCLUSION

Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.