title: 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.
abstract: 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.
authors.affiliation: Department of Otorhinolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: Joseph Tung-Chieh
authors.initials: JT
authors.lastname: Chang
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Shiang-Fu
authors.initials: SF
authors.lastname: Huang
authors.forename: I-How
authors.initials: IH
authors.lastname: Chen
authors.forename: Chuen
authors.initials: C
authors.lastname: Hsueh
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Ann-Joy
authors.initials: AJ
authors.lastname: Cheng
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
mesh_terms: 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
chemical_list: D019788:Fluorodeoxyglucose F18