¹⁸F-FDG Metabolic Tumor Volume and Total Glycolytic Activity of Oral Cavity and Oropharyngeal Squamous Cell Cancer: Adding Value to Clinical Staging

Abstract

18 F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). Methods: The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant singleinstitution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38%, 50%, and 60% of maximum standardized uptake value (SUV). The TGA is defined as MTV · mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. Results: In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95% confidence interval, 1.01-1.10; P 5 0.006) and 1.00 (95% confidence interval, 1.00-1.01; P 5 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (x 2 value change, 1.16-6.71; P 5 0.01) and when TGA was added to AJCC stage in model II (x 2 value change, 1.16-4.37; P 5 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P 5 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P 5 0.08), though the result was not statistically significant. Conclusion: Gradient-based segmentations of primary tumor MTV and TGA are potential 18 F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.

Metabolic Tumor Volume Measured by F-18 FDG PET/CT can Further Stratify the Prognosis of Patients with Stage IV Non-Small Cell Lung Cancer

“…Although SUVmax is convenient to measure and widely used, it has some limitations. SUVmax is a single-pixel value representing the most intense F-18 FDG uptake in the tumor and may not be an adequate surrogate marker to represent tumor biology [13]. In addition, SUVmax variability increases as the lesion matrix size and patient size increase [25].…”

“…Standardized uptake value (SUV)-based PET parameter can predict therapeutic outcome and overall survival in many types of malignancies [6][7][8][9][10][11][12]. Recently, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have been reported as additional diagnostic and prognostic imaging biomarkers for maximum SUV (SUVmax) [13][14][15]. MTV and TLG are valuable markers in the prediction of prognosis in NSCLC patients, mostly in operable or up to stage III patients [16][17][18].…”

Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis in Head and Neck Cancer: A Systematic Review and Meta-Analysis

“…Either MTV (2,(15)(16)(17) or TLG (18) was measured in 5 studies, and both were measured in 8 studies (8,(19)(20)(21)(22)(23)(24)(25). The VOI was defined as the tumor (2,8,(17)(18)(19)(20)(21)(22)(23) or tumor plus metastatic lymph nodes (LNs) (15,16,24,25). Three threshold methods were adapted to segment VOIs.…”

Addition of 18F-FDG PET/CT to Clinical Assessment Predicts Overall Survival in HNSCC: A Retrospective Analysis with Follow-up for 12 Years

“…Headandneckcanceri s the sixth most common type of cancer, representing about 6% of all cases and accounting for an estimated 650,000 new cancer cases and 350,000 cancer deaths worldwide each year (1)(2)(3)(4)(5). About 50%-70% of patients with head and neck squamous cell carcinoma (HNSCC) achieve a complete response, with residual or recurrent disease being detected in 30%-50% of cases either at the primary site or in the neck (6).…”