Abstract:
Objective To investigate the value of 18F-fluorodeoxyglucose (FDG) PET/CT related metabolic parameters in predicting epidermal growth factor receptor (EGFR) expression levels before the treatment of nasopharyngeal carcinoma (NPC).
Methods The clinical and PET/CT imaging data of 61 patients (44 males and 17 females, aged 21–84 (57.8±6.2) years) with NPC that was diagnosed via hiopathological examination and who were admitted to the Nuclear Medicine Department of Guangxi Liuzhou Worker's Hospital from January 2017 to November 2019 were retrospectively analyzed. The 18F-FDG PET/CT images of all patients were analyzed to calculate the maximum standard uptake value (SUVmax), tumor metabolic volume (MTV), and total lesion glycolysis (TLG). The samples of all patients were subjected to streptavidin-perosidase immunohistochemical staining, and the positive expression of EGFR was calculated. Gender, T stage, pathological classification, maximum tumor diameter, and other enumeration data were analyzed through χ2 test or Fisher's exact probability. Mann–Whitney U test was adopted for the comparison of SUVmax, MTV, and TLG between two samples. Independent samples t test was applied for the comparison of ages between groups. Single factorial Logistic regression equation was used for the analysis of clinicopathological factors and metabolic parameters to evaluate the predictors of EGFR expression levels, and factors (P<0.05) with statistical significance in single factorial analysis were included in the multiple factorial Logistic regression analysis model to evaluate the independent predictors of EGFR expression levels. The receiver operator characteristic (ROC) curves of the three groups of the metabolic parameters of patients with NPC were drawn to evaluate diagnostic efficacy.
Results The 61 NPC patients had positive EGFR expression rates of 93% (57/61). Among the patients, 34 had high EGFR expression levels and 27 had low EGFR expression levels. The SUVmax, MTV, and TLG of the high EGFR expression group were evidently higher than those of the low EGFR expression group (U=−4.197, −2.273, −2.425; all P<0.05). T stage and maximum tumor diameter were related to EGFR expression levels (χ2=11.128, 5.165; both P<0.05), whereas the difference in gender (χ2=0.720), age (t=−0.087), and pathological classification (χ2=1.914) between the high and low EGFR expression groups lacked statistical significance (all P>0.05). Single factorial regression analysis showed that patients with high T stage (OR=0.103, 95%CI: 0.018–0.582, P=0.025), maximum tumor diameter (OR=1.612, 95%CI: 1.090–2.385, P=0.017), SUVmax (OR=1.270, 95%CI: 1.115–1.446, P<0.01), MTV (OR=1.008, 95%CI: 1.002–1.014, P=0.015), and TLG (OR=1.085, 95%CI: 1.015–1.160, P=0.016) were likely to have high EGFR expression, and multiple factorial regression analysis indicated that SUVmax (OR=1.340, 95%CI: 1.019–1.764, P=0.036) was the independent predictor of high EGFR expression levels. The ROC curves indicated that the diagnostic efficacy of SUVmax (AUC=0.815, 95%CI: 0.709–0.921, P<0.01) in predicting high EGFR expression levels was obviously superior to that of MTV (AUC=0.682, 95%CI: 0.548–0.816, P=0.015) and TLG (AUC=0.670, 95%CI: 0.535–0.805, P=0.023). When the critital values of SUVmax, MTV and TLG were 16.39, 136.29 cm3, 19.28 respectively, the sensitivities were 58.8%, 50.0%, and 41.2%, respectively, and the specificities were 96.3%, 85.2%, and 96.3%, respectively.
Conclusions The metabolic parameter SUVmax of 18F-FDG PET/CT can serve as the independent predictor of EGFR expression levels in patients with NPC. Moreover, 18F-FDG PET/CT examination can enable the noninvasive assessment of EGFR expression levels.
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