Prognostic Significance of the Intratumoral Heterogeneity of 18F-FDG Uptake in Oral Cavity Cancer

BackgroundsWe evaluated the prognostic value of the intratumoral heterogeneity of F-18-FDG uptake in oral cavity cancer. Materials and MethodsWe enrolled 45 patients who underwent pretreatment F-18-FDG PET/CT. The intratumoral heterogeneity of F-18-FDG uptake was represented as the heterogeneity factor (HF), defined as the derivative (dV/dT) of a volume-threshold function for a primary tumor. We measured the maximum standardized uptake value (SUVmax) and volumetric PET parameters. The relationship between HF and clinical parameters, as well as other PET parameters, was evaluated. ResultsThe HF was significantly correlated with SUVmax (r=-0.353, P=0.017), metabolic tumor volume (r=-0.708, P<0.0001), and total lesion glycolysis (r=-0.709, P<0.0001). A multivariate analysis revealed not only cervical lymph node metastasis (hazard ratio=5.983; P=0.022) but also HF (hazard ratio=2.49x10(-4); P=0.002) to be independent predictors of overall survival. Those patients with HF<-0.13 showed a worse prognosis than those with HF -0.13 (P=0.005). ConclusionsThe intratumoral heterogeneity of F-18-FDG uptake may be a significant prognostic factor for overall survival in addition to cervical lymph node metastasis in oral cavity cancer. J. Surg. Oncol. 2014 110:702-706. (c) 2014 Wiley Periodicals, Inc.