The aims of this multicenter study were to identify clinical and preoperative PET/CT parameters predicting overall survival (OS) and distant metastasis–free survival (DMFS) in a cohort of head and neck squamous cell carcinoma patients treated with surgery, to generate a prognostic model of OS and DMFS, and to validate this prognostic model with an independent cohort. Methods: A total of 382 consecutive patients with head and neck squamous cell carcinoma, divided into training (n = 318) and validation (n = 64) cohorts, were retrospectively included. The following PET/CT parameters were analyzed: clinical parameters, SUV_max, SUV_mean, metabolic tumor volume (MTV), total lesion glycolysis, and distance parameters for the primary tumor and lymph nodes defined by 2 segmentation methods (relative SUV_max threshold and absolute SUV threshold). Cox analyses were performed for OS and DMFS in the training cohort. The concordance index (c-index) was used to identify highly prognostic parameters. These prognostic parameters were externally tested in the validation cohort. Results: In multivariable analysis, the significant parameters for OS were T stage and nodal MTV, with a c-index of 0.64 (P < 0.001). For DMFS, the significant parameters were T stage, nodal MTV, and maximal tumor–node distance, with a c-index of 0.76 (P < 0.001). These combinations of parameters were externally validated, with c-indices of 0.63 (P < 0.001) and 0.71 (P < 0.001) for OS and DMFS, respectively. Conclusion: The nodal MTV associated with the maximal tumor–node distance was significantly correlated with the risk of DMFS. Moreover, this parameter, in addition to clinical parameters, was associated with a higher risk of death. These prognostic factors may be used to tailor individualized treatment.

这项多中心研究的目的是确定临床和术前 PET/CT 参数，这些参数可预测一组接受手术治疗的头颈部鳞状细胞癌患者的总生存期 (OS) 和无远处转移生存期 (DMFS)，从而生成预后OS 和 DMFS 模型，并通过独立队列验证该预后模型。方法：总共 382 名连续的头颈部鳞状细胞癌患者被回顾性纳入，分为训练队列（n = 318）和验证队列（n = 64）。分析了以下 PET/CT 参数：临床参数、SUV_最大值、SUV_平均值、代谢肿瘤体积 (MTV)、总病变糖酵解以及原发肿瘤和淋巴结的距离参数，这些参数由 2 种分割方法（相对 SUV_最大阈值和绝对 SUV 阈值）定义。对训练队列中的 OS 和 DMFS 进行了 Cox 分析。一致性指数（c-指数）用于确定高度预后参数。这些预后参数在验证队列中进行了外部测试。结果：在多变量分析中，OS 的重要参数是 T 分期和淋巴结 MTV，c 指数为 0.64（P < 0.001）。对于 DMFS，重要参数是 T 分期、淋巴结 MTV 和最大肿瘤-淋巴结距离，c 指数为 0.76 ( P< 0.001)。这些参数组合经过外部验证， OS 和 DMFS 的c 指数分别为 0.63 ( P < 0.001) 和 0.71 ( P < 0.001)。结论：与最大肿瘤-淋巴结距离相关的淋巴结 MTV 与 DMFS 风险显着相关。此外，除临床参数外，该参数还与更高的死亡风险相关。这些预后因素可用于定制个体化治疗。