Correlation of pretreatment 18F-FDG PET tumor textural features with gene expression in pharyngeal cancer and implications for radiotherapy-based treatment outcomes

  • Shang-Wen Chen
  • Wei-Chih Shen
  • Ying-Chun Lin
  • Rui-Yun Chen
  • Te-Chun Hsieh
  • Kuo-Yang Yen
  • Chia-Hung Kao
Original Article

DOI: 10.1007/s00259-016-3580-5

Cite this article as:
Chen, SW., Shen, WC., Lin, YC. et al. Eur J Nucl Med Mol Imaging (2017) 44: 567. doi:10.1007/s00259-016-3580-5



This study investigated the correlation of the matrix heterogeneity of tumors on 18F-fluorodeoxyglucose positron emission tomography–computed tomography (PET–CT) with gene-expression profiling in patients with pharyngeal cancer and determined the prognostic factors for radiotherapy-based treatment outcomes.


We retrospectively reviewed the records of 57 patients with stage III–IV oropharyngeal or hypopharyngeal cancer who had completed definitive therapy. Four groups of the textural features as well as 31 indices were studied in addition to maximum standard uptake value, metastatic tumor volume, and total lesion glycolysis. Immunohistochemical data from pretreatment biopsy specimens (Glut1, CAIX, VEGF, HIF-1α, EGFR, Ki-67, Bcl-2, CLAUDIN-4, YAP-1, c-Met, and p16) were analyzed. The relationships between the indices and genomic expression were studied, and the robustness of various textural features relative to cause-specific survival and primary relapse-free survival was analyzed.


The overexpression of VEGF was positively associated with the increased values of the matrix heterogeneity obtained using gray-level nonuniformity for zone (GLNUz) and run-length nonuniformity (RLNU). Advanced T stage (p = 0.01, hazard ratio [HR] = 3.38), a VEGF immunoreactive score of >2 (p = 0.03, HR = 2.79), and a higher GLNUz value (p = 0.04, HR = 2.51) were prognostic factors for low cause-specific survival, whereas advanced T stage, a HIF-1α staining percentage of ≥80%, and a higher GLNUz value were prognostic factors for low primary-relapse free survival.


The overexpression of VEGF was associated with the increased matrix index of GLNUz and RLNU. For patients with pharyngeal cancer requiring radiotherapy, the treatment outcome can be stratified according to the textural features, T stage, and biomarkers.


Head and neck cancer 18F-fluorodeoxyglucose positron emission Textural analysis Genomic expression 







Clinical target volumes


Gray-level nonuniformity for zone


Gross tumor volume


Head and neck squamous cell carcinoma


Human papilloma virus


Metastatic tumor volume


Positron emission tomography-computed tomography


Run-length nonuniformity




Standardized uptake value


Total lesion glycolysis

Funding information

Funder NameGrant NumberFunding Note
Ministry of Health and Welfare
  • MOHW105-TDU-B-212-133019

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Shang-Wen Chen
    • 1
    • 2
    • 3
    • 4
  • Wei-Chih Shen
    • 5
    • 6
  • Ying-Chun Lin
    • 1
    • 7
  • Rui-Yun Chen
    • 8
  • Te-Chun Hsieh
    • 9
    • 10
  • Kuo-Yang Yen
    • 9
    • 10
  • Chia-Hung Kao
    • 4
    • 9
    • 11
  1. 1.Department of Radiation OncologyChina Medical University HospitalTaichungTaiwan
  2. 2.School of MedicineChina Medical UniversityTaichungTaiwan
  3. 3.School of MedicineTaipei Medical UniversityTaipeiTaiwan
  4. 4.Graduate Institute of Clinical Medical Science, School of Medicine, College of MedicineChina Medical UniversityTaichungTaiwan
  5. 5.Cancer Center and Department of Medical Research, China Medical University HospitalChina Medical UniversityTaichungTaiwan
  6. 6.Department of Computer Science and Information EngineeringAsia UniversityTaichungTaiwan
  7. 7.The Ph.D. Program for Cancer Biology and Drug DiscoveryChina Medical University and Academia SinicaTaichungTaiwan
  8. 8.Department of PathologyChina Medical University HospitalTaichungTaiwan
  9. 9.Department of Nuclear Medicine and PET CenterChina Medical University HospitalTaichungTaiwan
  10. 10.Department of Biomedical Imaging and Radiological ScienceChina Medical UniversityTaichungTaiwan
  11. 11.Department of Bioinformatics and Medical EngineeringAsia UniversityTaichungTaiwan

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