High 2-[F]fluoro-2-deoxy-d-glucose (FDG) 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-[¹⁸F]fluoro-2-deoxy-d-glucose (¹⁸FDG) 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. ¹⁸FDG uptake in the primary tumor site was quantified by calculation of the maximum standardized uptake values (SUV_max). Subsequent statistical analyses found, that ¹⁸FDG 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, ¹⁸FDG uptake detected by PET predicts adverse outcome of patients with OSCC in this retrospective analysis. ¹⁸FDG–PET might be a promising tool to contribute to therapeutic decisions and should be evaluated in future prospective studies.