Total lesion glycolysis: A possible new prognostic parameter in oral cavity squamous cell carcinoma

South Egypt Cancer Institute

Assiut University

Total lesion glycolysis: A possible new prognostic parameter in oral cavity squamous cell carcinoma

Research Authors
Abd El-Hafez YG
Moustafa HM
Khalil HF
Liao CT
Yen TC.
Research Member
Yasser Gaber Ali Abdelhafez
Research Department
Department of Radiotherapy and Nuclear medicine
Research Year
2013
Research Journal
Oral oncology
Research Publisher
Elsevier
Research Vol
49(3)
Research Rank
1
Research_Pages
261-268
Research Website
https://doi.org/10.1016/j.oraloncology.2012.09.005
Research Abstract

OBJECTIVES:

We sought to determine potential prognostic value of total lesion glycolysis (TLG) calculated from combined positron emission tomography/computed tomography (PET/CT) in patients with oral cavity squamous cell carcinoma (OSCC).
MATERIALS AND METHODS:

We prospectively studied 126 patients with OSCC who underwent PET/CT before definitive treatment by radical surgery. The metabolic tumor volume (MTV) was calculated for the primary tumor according to an absolute standardized uptake value (SUV) of 3. TLG was calculated as MTV × the average SUV. The nodal SUVmax was also recorded. The median value of SUVmax and TLG were used to divide the patients into two categories (high and low). Patients were followed up until death or for at least 24 months from their surgery. Disease-free (DFS) and disease-specific survivals (DSS) were the main outcome measures.
RESULTS:

The median TLG of the primary tumor ((T)TLG) was 71.4, and the median nodal SUVmax ((N)SUV) was 7.5. Patients with high (T)TLG (≥ median) had a 2-year DFS of 52% whereas the DFS was 74% for those with a low (T)TLG (P=0.007); the 2-year-DSS rates were 53% vs. 84%, respectively (P<0.001). Similarly, patients with high (N)SUVmax (≥ median) had a 2-year DFS of 42% vs. 70% for patients with a low (N)SUVmax (P=0.001); the 2-year-DSS rates were 39% vs. 78%, respectively (P<0.001). In multivariate analyses, (T)TLG, (N)SUVmax, and pathological nodal status were independent prognostic factors for the 2-year DSS. A 3-point prognostic scoring system was formulated based on the presence or absence of the independent factors. Patients with positive neck nodes, high (N)SUVmax, and high (T)TLG (score 3) had a 32-fold higher risk of cancer death compared with those lacking such risk factors (2-year-DSS=26% vs. 97%, P<0.001).
CONCLUSION:

Primary tumor TLG is an independent prognostic factor for cancer control and survival in patients with OSCC. A prognostic scoring system that includes primary tumor TLG, nodal SUVmax, and pathological neck status may be useful for risk stratification in this group of patients.