High 2-[18F]fluoro-2-deoxy-d-glucose (18FDG) uptake measured by positron emission tomography is associated with reduced overall survival in patients with oral squamous cell carcinoma

Patients with oral squamous cell carcinoma (OSCC) and poor prognosis may benefit from an intensification of the initial therapy scheme. To improve the clinical management of these patients, there is a strong requirement for an accurate assessment of the malignant properties of the individual lesion. The objective of the present analysis was to define the potential value of 2-[(18)F]fluoro-2-deoxy-d-glucose ((18)FDG) uptake in the tumor measured by positron emission tomography (PET) in predicting patients' outcome in the clinical course of OSCC. In this respect, a clinically well-defined cohort of 79 patients with primary OSCC was retrospectively evaluated. (18)FDG uptake in the primary tumor site was quantified by calculation of the maximum standardized uptake values (SUV(max)). Subsequent statistical analyses found, that (18)FDG uptake of the primary tumor was significantly higher in stage T3/T4 vs. T1/T2 (p<0.001), in UICC stage IV vs. stage I-III (p=0.01), and in N1-3 vs. N0 tumors (p<0.001), respectively. To define SUV(max) cut-off values for survival analyses, receiver operating curves (ROC) were calculated for overall and disease-free survival after 36 and 60 months, respectively. Univariate survival analysis showed that high SUV(max) was significantly associated with shortened overall survival after 36 (p=0.026) and 60 months (p=0.02). Subsequent multi-variate Cox regression analysis including SUV(max), age, gender and UICC stage as co-variables determined that, high SUV(max) was the only predictor of inferior overall survival after 60 months (p=0.035) in this model. In conclusion, (18)FDG uptake detected by PET predicts adverse outcome of patients with OSCC in this retrospective analysis. (18)FDG-PET might be a promising tool to contribute to therapeutic decisions and should be evaluated in future prospective studies.