PREDICTION OF SURVIVAL WITH FLUORINE-18-FLUORODEOXYGLUCOSE AND PET INHEAD AND NECK-CANCER

The aim of this prospective study was to investigate if high uptake of F-18-fluoro-2-deoxy-D-glucose (FDG) is associated with aggressiveness in head and neck cancer and low probability of survival. Methods: Thi rty-seven patients with squamous-cell carcinoma of the head and neck u nderwent FDG-PET in the fasting state before cancer treatment. FDG upt ake in primary tumor was quantitated as the standardized uptake value of FDG normalized to the predicted lean body mass (SUVlean, n = 37) an d as the graphically determined metabolic rate for FDG (rMR(FDG), n = 34). Paraffin-embedded tumor samples were used for histologic evaluati on, and expression of cytokeratin and Ki-67 antigen were assessed by i mmunohistochemistry. Results: Interobserver agreement for the determin ation of quantitative uptake of FDG in tumors was excellent (r(2) = 0. 996, p < 0.00001), and all 37 primary tumors were visualized. A high u ptake of FDG as assessed by SUVlean was associated with a higher than the median mitotic count (p = 0.01), absence of keratinization (p = 0. 03), low or moderate histological grade of differentiation (p = 0.046) and advanced stage (p = 0.03), but not with Ki-67 expression (p = 0.1 1). The overall survival of patients with a SUVlean lower than or equa l to the median value (9.0) was clearly better in univariate analysis than that of patients with a SUVlean higher than the median (3-yr surv ival 73% versus 22%, relative risk of death (RR) 4.2, 1.6-11.0). Howev er, in a multivariate analysis the only independent predictors of surv ival were the mitotic count (RR 4.0, 1.4-11.7) and stage (3.8, 1.2-12. 2), Conclusion: High uptake of FDG in untreated head and neck cancer i s associated with advanced disease, and may portend poor survival. Agg ressive treatment approaches should be considered for patients present ing with a tumor with high uptake of FDG.