Maximum Standardized Uptake Value (SUVmax) of Primary Tumor Predicts Occult Neck Metastasis in Oral Cancer

Grégoire B Morand,Martin W Huellner,Gerhard F Huber,Jonas Werner,Domenic G Vital,Sandro J Stoeckli,Ken Kudura

doi:10.1038/s41598-018-30111-7

Grégoire B Morand, Martin W Huellner + Show 5 more

Open Access

https://doi.org/10.1038/s41598-018-30111-7

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Abstract

The aim of this study was to investigate the predictability of occult lymph node metastasis using maximum standardized uptake value (SUVmax) in the primary tumor on pre-treatment 18-fluorodeoxyglucose positron emission tomography FDG-PET in oral squamous cell carcinoma (OSCC) patients who were clinically node negative (cN0) before surgery. A retrospective analysis of all patients treated at the University Hospital Zurich from 2007 to 2016 for OSCC with available pre-therapeutic FDG-PET was performed. We assessed the correlation of SUVmax of the primary tumors with the presence of occult nodal disease in the neck dissection specimen (pN+). The study included a total of 71 patients. In the nodal negative group (cN0/pN0), the median SUVmax of primary tumors was 9.0 (interquartile range (IQR) 7.4–13.9), while it was 11.4 (IQR 9.9–15.7) in the occult metastatic group (cN0/pN+). The difference was statistically significant (independent samples median test, P = 0.037). In a multivariable model, the only independent predictor of occult metastatic disease for cN0 patients was a SUVmax ≥ 9.5 (P = 0.028). Further, primary tumors with SUVmax ≥ 9.5 had a significantly higher risk of local recurrence (Log rank test, P = 0.020). In conclusion, we showed that higher SUVmax (≥9.5) of the primary tumor is associated with higher occurrence of occult metastatic nodal disease and worse local survival. High SUVmax of the primary tumor may encourage clinicians towards more aggressive treatment.

Highlights

Oral squamous cell carcinoma (OSCC) is an aggressive malignancy characterized by local invasiveness and high propensity to lymph node metastases[1,2]
This study evaluates in a cohort of OSCC the predictability of occult lymph node metastasis by PET/CT metabolic parameters of the primary tumor
For total lesion glycolysis (TLG), we observed similar correlations to those observed for SUVmax

Summary

Introduction

Oral squamous cell carcinoma (OSCC) is an aggressive malignancy characterized by local invasiveness and high propensity to lymph node metastases[1,2]. Several clinical parameters have been proposed to increase the predictability of occult lymph node metastasis[12], such as depth of invasion (DOI) or immunohistochemical staining e.g. for CD44 (Morand et al, Head Neck, submitted), podoplanin[13], E-cadherin. While DOI is measurable on conventional CT or MR images, FDG-PET provides further diagnostic information on tumor metabolism Such parameters include the maximum standardized uptake value (SUVmax), metabolic tumor volume www.nature.com/scientificreports/. They have been reported e.g. in lung cancer to correlate with the occurrence of occult lymph node metastasis[17,18]. In OSCC, the literature is scarce and it is presently unknown if metabolic parameters derived from FDG-PET/CT can predict occult neck disease. We assessed the correlation between metabolic parameters derived from FDG-PET/CT or FDG-PET/MR metabolic parameters and occult neck disease

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