Preoperative [18F]-fluorodeoxyglucose positron emission tomography standardized uptake value of neck lymph nodes may aid in selecting patients with oral cavity squamous cell carcinoma for salvage therapy after relapse.
OBJECTIVE
Relapse of tumours in patients with oral cavity squamous cell carcinoma (OSCC) is associated with a dismal outcome. In this prospective study, we sought to investigate the clinical significance of the preoperative maximal standardized uptake value (SUVmax) at the neck lymph nodes in selecting patients with OSCC for salvage therapy after relapse.


METHODS
Between 2002 and 2007, 108 patients with early relapse of OSCC (n=75) or late relapse of OSCC (n=33) were identified. Salvage therapy was performed in 47 patients. All patients underwent 2-deoxy-2[(18)F]-fluoro-D: -glucose positron emission tomography during the 2 weeks before surgery and neck dissection. All patients were followed for 12 months or more after surgery or until death. The optimal cut-off value for the neck lymph node SUVmax (SUVnodal-max) was selected according to the 5-year disease-specific survival (DSS) rate. Independent risk factors were identified by Cox regression analysis.


RESULTS
The mean follow-up for all patients was 20.3 months (41.1 months for surviving patients). In the early relapse group, several prognostic factors were identified in univariate and multivariate analyses, including a SUVnodal-max value of >or=4.2. A scoring system based on univariate analysis was formulated. Patients with a score of 0 had a better 5-year DSS than those with scores of 1 or higher (58% vs. 5%, p=0.0003). In patients with late relapse, a SUVnodal-max value of >or=4.2 had the highest prognostic value for predicting the 5-year DSS (45% vs. 0%, p=0.0005).


CONCLUSIONS
Among patients with relapsed OSCC, the SUVnodal-max value may aid in selecting patients for salvage therapy.
Liao
Chun-Ta
CT
Department of Otorhinolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
Chang
Joseph Tung-Chieh
JT
Wang
Hung-Ming
HM
Ng
Shu-Hang
SH
Huang
Shiang-Fu
SF
Chen
I-How
IH
Hsueh
Chuen
C
Lee
Li-Yu
LY
Lin
Chih-Hung
CH
Cheng
Ann-Joy
AJ
Yen
Tzu-Chen
TC
D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism*; D008297:Male; D009055:Mouth / Q000473:pathology; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery / Q000628:therapy*; D015999:Multivariate Analysis; D009333:Neck; D018579:Patient Selection; D049268:Positron-Emission Tomography; D057234:Preoperative Period; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors
D019788:Fluorodeoxyglucose F18