Total lesion glycolysis: A possible new prognostic parameter in oral cavity squamous cell carcinoma

• Published in: Oral oncology 2013-03, Vol.49 (3), p.261-268
• Main Authors: Abd El-Hafez, Yasser G, Moustafa, Hosna M, Khalil, Haytham F, Liao, Chun-Ta, Yen, Tzu-Chen
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Carcinoma, Squamous Cell - metabolism; Carcinoma, Squamous Cell - surgery; Chemoradiotherapy; Cisplatin - therapeutic use; Dermatology; Disease-Free Survival; Female; Fluorodeoxyglucose; Fluorodeoxyglucose F18; Follow-Up Studies; Glycolysis - physiology; Hematology, Oncology and Palliative Medicine; Humans; Image Processing, Computer-Assisted - methods; Lymph Nodes - metabolism; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Mouth Neoplasms - metabolism; Mouth Neoplasms - surgery; Multimodal Imaging - methods; Neck Dissection - methods; Neoplasm Staging; Oral cancer; Otolaryngology; Otorhinolaryngology. Stomatology; Positron emission tomography computed tomography; Positron-Emission Tomography; Prognosis; Prospective Studies; Radiopharmaceuticals; Radiotherapy Dosage; Radiotherapy, Adjuvant; Risk Assessment; Squamous cell carcinoma; Tomography, X-Ray Computed; Total lesion glycolysis; Treatment Outcome; Tumor volume; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2012.09.005

Summary Objectives We sought to determine potential prognostic value of total lesion glycolysis (TLG) calculated from combined positron emission tomography/computed tomography (PET/CT) in patients with oral cavity squamous cell carcinoma (OSCC). Materials and methods We prospectively studied 126 patients with OSCC who underwent PET/CT before definitive treatment by radical surgery. The metabolic tumor volume (MTV) was calculated for the primary tumor according to an absolute standardized uptake value (SUV) of 3. TLG was calculated as MTV × the average SUV. The nodal SUVmax was also recorded. The median value of SUVmax and TLG were used to divide the patients into two categories (high and low). Patients were followed up until death or for at least 24 months from their surgery. Disease-free (DFS) and disease-specific survivals (DSS) were the main outcome measures. Results The median TLG of the primary tumor (T TLG) was 71.4, and the median nodal SUVmax (N SUV) was 7.5. Patients with highT TLG (⩾median) had a 2-year DFS of 52% whereas the DFS was 74% for those with a lowT TLG ( P = 0.007); the 2-year-DSS rates were 53% vs. 84%, respectively ( P < 0.001). Similarly, patients with highN SUVmax (⩾median) had a 2-year DFS of 42% vs. 70% for patients with a lowN SUVmax ( P = 0.001); the 2-year-DSS rates were 39% vs. 78%, respectively ( P < 0.001). In multivariate analyses,T TLG,N SUVmax, and pathological nodal status were independent prognostic factors for the 2-year DSS. A 3-point prognostic scoring system was formulated based on the presence or absence of the independent factors. Patients with positive neck nodes, highN SUVmax, and highT TLG (score 3) had a 32-fold higher risk of cancer death compared with those lacking such risk factors (2-year-DSS = 26% vs. 97%, P < 0.001). Conclusion Primary tumor TLG is an independent prognostic factor for cancer control and survival in patients with OSCC. A prognostic scoring system that includes primary tumor TLG, nodal SUVmax, and pathological neck status may be useful for risk stratification in this group of patients.