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KEMORADYOTERAPİ İLE TEDAVİ EDİLEN BAŞ VE BOYUN SKUAMÖZ HÜCRELİ KANSERİNDE BİLGİSAYARLI TOMOGRAFİ HİSTOGRAM ANALİZİNİN SAĞKALIM SÜRESİ VE LOKAL KONTROL SÜRESİ İLE İLİŞKİSİNİN ARAŞTIRILMASI

AMAÇ: Bu çalışmada kemoradyoterapi ile tedavi edilen baş ve boyun skuamöz hücreli kanserinde (BBSHK) bilgisayarlı tomografi (BT) histogram analizi ile sağkalım süresi ve lokal kontrol süresi arasındaki ilişkisinin değerlendirilmesi hedeflenmiştir. GEREÇ VE YÖNTEM: Çalışmamızda ‘Kanser Görüntüleme Arşivi’ veri tabanında kayıtlı ‘Baş ve Boyun Skuamöz Hücreli Kanserleri’ isimli çalışmaya ait veri seti ve bu çalışmaya kayıtlı olguların BT görüntüleri kullanılmıştır. Tümöre ait Human papilloma virüs (HPV) durumu bilinen, konkomitan kemoradyoterapi ile tedavi edilmiş ve tedavi öncesi 1.3 mm kesit kalınlığında kontrastlı boyun BT incelemesi bulunan olgular çalışmaya dahil edilmiştir. 112 tümör ve 98 lenfadenopatiden BT histogram analizi gerçekleştirilmiştir. Lezyonların en geniş boyuta ulaştığı aksiyel kesit belirlenerek bu kesitte lezyon sınırları nekrotik-kistik alanları da içerecek şekilde çizilmiş ve bu alan üzerinden histogram parametreleri [ortalama, varyans, çarpıklık, kurtozis, 1.persentil (P), 10.P, 50.P, 90.P ve 99.P] hesaplanmıştır. Histogram parametrelerinin sağkalım süresi ve lokal kontrol süresi ile ilişkisi Kaplan Meier yöntemi ve tek değişkenli ve çok değişkenli Cox regresyon analizleri ile değerlendirilmiştir. BULGULAR: Çalışmaya 95 erkek, 17 kadın olgu dahil edilmiştir (ortalama yaş 59.12±9.54 yıl). Ortalama sağkalım süresi 69.3 ay, ortalama lokal kontrol süresi 68.4 ay ve 5 yıllık sağkalım oranı %84’tür. Yaş, cinsiyet, sigara öyküsü, kanser orijini, T (tümör) evresi, N (lenf nodu) evresi, TNM (tümör-lenf nodu-metastaz) evresi ve HPV durumuna göre düzeltme yapılarak çok değişkenli Cox regresyon analizi yapıldığında lenfadenopati histogram parametrelerinden ortalama değer, 50.P, 90.P ve 99.P değerlerinin sağkalım süresini; tümör histogram parametrelerinden ortalama değer, 1.P ve 10.P değerlerinin lokal kontrol süresini tahmin etmede bağımsız belirteçler olduğu bulunmuştur. SONUÇ: Tedavi öncesi evreleme amaçlı sıklıkla kullanılan BT’den gerçekleştirilecek histogram analizi kemoradyoterapi ile tedavi edilen BBSHK’de sağkalım ve lokal kontrol sürelerinin öngörülmesinde klinik faktörlere ek katkı sağlayabilir.

Anahtar Kelimeler:

Baş ve boyun skuamöz hücre karsinomu, Bilgisayarlı tomografi, Histogram analizi, Sağkalım, Lokal kontrol

INVESTIGATION OF THE RELATIONSHIP OF COMPUTED TOMOGRAPHY HISTOGRAM ANALYSIS WITH SURVIVAL TIME AND LOCAL CONTROL TIME IN HEAD AND NECK SQUAMOUS CELL CARCINOMA TREATED WITH CHEMORADIOTHERAPY

OBJECTIVE: This study aimed to evaluate the association between computed tomography (CT) histogram analysis and overall survival and local control in head and neck squamous cell carcinoma (HNSCC) treated with chemoradiotherapy. MATERIAL AND METHODS: Data archive and CT images from the ‘HNSCC’ study, which is publicly available on ‘The Cancer Imaging Archive’ website, were used in this study. Patients with known Human papilloma virus (HPV) status of the tumor who were treated with concurrent chemoradiotherapy and had pretreatment contrast-enhanced neck CT examination with a slice thickness of 1.3 mm were included. Histogram analysis was performed on 112 tumors and 98 lymphadenopathies. Tumor and lymphadenopathy boundaries, including cystic and necrotic areas, were manually drawn from a single axial CT slice where the lesion size was the largest. Then, histogram parameters [mean, variance, skewness, kurtosis, 1st percentile (P), 10th P, 50th P, 90th P, 99th P] were calculated from the corresponding areas. Kaplan Meier method and univariate and multivariate Cox proportional hazard models were used to examine the association between CT histogram parameters and overall survival and local control. RESULTS: 95 males and 17 females were included in this study (mean age 59±9.54 years). Mean overall survival was 69.3 months, local control duration was 68.4 months, and the five-year survival rate was 84%. Multivariate Cox proportional hazard model adjusted for age, sex, smoking, HPV status, and primary tumor T (tumor), N (lymph node), and TNM (tumor-lymph node-metastasis) stages showed that mean, 50th P, 90th P, 99th P values of the lymphadenopathy were independent predictors of overall survival, and mean, 1st P, 10th P values of the tumor were independent predictors of local control. CONCLUSIONS: CT histogram analysis could serve as a pretreatment noninvasive biomarker for predicting overall survival and local control in HNSCC treated with chemoradiotherapy.

Keywords:

Head and neck squamous cell carcinoma, computed tomography, histogram analysis, overall survival, local control,

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