Prognostic value of pretreatment 18F-FDG PET/CT parameters including visual evaluation in patients with head and neck squamous cell carcinoma

Objectives The purpose of this study was to determine whether pretreatment quantitative and visual parameters seen on PET/CT using 18F-FDG add prognostic information for clinical staging in patients with head and neck squamous cell carcinoma (HNSCC).

Methods We enrolled 108 patients with histologically proven oral, oropharyngeal, hypopharyngeal, and laryngeal SCCs who underwent FDG-PET/CT before treatment. PET/CT parameters—maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and uptake pattern—were recorded. We classified the uptake patterns into two groups: sphere-shaped or ring-shaped. The prognostic value of these parameters was evaluated using univariate Cox regression analysis. Multivariate analysis was then applied to examine the effect of these PET/CT parameters adjusted for other covariates.

Results In univariate analysis, all of the FDG PET/CT parameters—SUVmax (> 10) of the primary tumor, MTV (> 20 cm3), TLG (> 70), and uptake pattern (ring-shaped)—were significantly associated with negative effects on disease-specific survival (DSS) and disease-free survival (DFS). In multivariate analysis, the MTV and uptake pattern remained associated with DSS after correcting for the AJCC stage and definitive therapy (P = 0.023 and < 0.001, respectively). SUVmax and TLG were not significantly associated with DSS (P = 0.055 and 0.050, respectively). Another DSS model that included MTV as a continuous variable, uptake pattern, and AJCC stage showed that MTV was not significantly associated with DSS (P = 0.332), but the uptake pattern remained significant (P < 0.001).

Conclusions Our data indicate that pretreatment quantitative and qualitative PET/CT parameters had prognostic value. In particular, a qualitative factor, "uptake pattern," provided important prognostic information about our patients.