Pre-treatment metabolic tumor volume predicts tumor metastasis and progression in high-grade salivary gland carcinoma
High-grade salivary gland carcinoma (SGC) shows a high rate of metastasis and post-treatment recurrence, resulting in poor patient survival. Therefore, we evaluated the utility of pre-treatment 18F-FDG PET/CT parameters in predicting metastasis, tumor progression, and survival of high-grade SGC patients.
This observational study included 75 patients with previously untreated high-grade SGC who underwent pre-treatment 18F-FDG PET/CT scanning and subsequent treatment. Standardized uptake values (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured on pre-treatment 18F-FDG PET/CT. Logistic regression analysis was used to identify the relationship of these factors with metastasis. Cox proportional hazard regression analyses were used to identify associations between PET parameters and both progression-free survival (PFS) and overall survival (OS).
A total of 36 (48%) patients had neck or distant metastases at initial staging. After controlling for clinical factors, MTV (> 8.8 mL) was an independent factor for initial metastasis (adjusted odds ratio 4.80, 95% confidence interval 1.09–21.20; P = 0.039). All PET parameters of SUVmax (> 4.3), SUVmean (> 3.0), SUVpeak (3.9), MTV (> 8.8 mL), and TLG (> 31.1 g) were significant variables for PFS (all P < 0.05), while MTV and TLG were significant factors for OS. After controlling for clinicopathological factors, MTV (adjusted hazard ratio 4.36, 95% confidence interval 1.69–11.26; P = 0.002) and TLG (3.41, 1.47–7.91; P = 0.004) were significantly associated with PFS, but not OS.
MTV is useful among quantitative PET measurements for predicting initial metastasis and PFS in patients with high-grade SGC.
KeywordsHigh-grade salivary gland cancer Metastasis 18F-FDG PET/CT Metabolic tumor volume Risk factors
This study was supported by a Grant (no. 2015R1A2A1A15054540) from Basic Science Research Program through the National Research Foundation of Korea (NRF), Ministry of Science and ICT, Seoul, Republic of Korea (J.L. Roh).
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent from all individual participants was waved because of the retrospective nature of this study.
- Abgral R, Keromnes N, Robin P, Le Roux PY, Bourhis D, Palard X, Rousset J, Valette G, Marianowski R, Salaun PY (2014) Prognostic value of volumetric parameters measured by 18F-FDG PET/CT in patients with head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging 41(4):659–667CrossRefGoogle Scholar
- Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, Oyen WJ, Kotzerke J, Hoekstra OS, Pruim J, Marsden PK, Tatsch K, Hoekstra CJ, Visser EP, Arends B, Verzijlbergen FJ, Zijlstra JM, Comans EF, Lammertsma AA, Paans AM, Willemsen AT, Beyer T, Bockisch A, Schaefer-Prokop C, Delbeke D, Baum RP, Chiti A, Krause BJ (2010) FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 37(1):181–200CrossRefGoogle Scholar
- Edge SB, Compton BD, Fritz CC, Greene AG, Trotti FL A (2010) Major salivary gland. In: AJCC cancer staging manual, 7th edn. Springer, New York, pp 79–86Google Scholar
- Eveson JW, Auclair P, Gnepp DR, El-Naggar AK (2005) Tumours of the salivary glands. In: Leon B, Eveson JW, Reichart P, Sidransky D (eds) World health organization classification of tumours. Pathology & genetics—head and neck tumours. IARC Press, Lyon, pp 209–281Google Scholar
- Haderlein M, Scherl C, Semrau S, Lettmaier S, Uter W, Neukam FW, Iro H, Agaimy A, Fietkau R (2016) High-grade histology as predictor of early distant metastases and decreased disease-free survival in salivary gland cancer irrespective of tumor subtype. Head Neck, 38 Suppl 1:E2041–E2048CrossRefGoogle Scholar
- Hosni A, Huang SH, Goldstein D, Xu W, Chan B, Hansen A, Weinreb I, Bratman SV, Cho J, Giuliani M, Hope A, Kim J, O’Sullivan B, Waldron J, Ringash J (2016) Outcomes and prognostic factors for major salivary gland carcinoma following postoperative radiotherapy. Oral Oncol 54:75–80CrossRefGoogle Scholar
- Kim D, Kim W, Lee J, Ki Y, Lee B, Cho K, Kim S, Nam J, Lee J, Kim D (2016) Pretreatment maximum standardized uptake value of (18)F-fluorodeoxyglucose positron emission tomography as a predictor of distant metastasis in adenoid cystic carcinoma of the head and neck. Head Neck 38(5):755–761CrossRefGoogle Scholar
- Nair VJ, MacRae R, Sirisegaram A, Pantarotto JR (2014) Pretreatment [18F]-fluoro-2-deoxy-glucose positron emission tomography maximum standardized uptake value as predictor of distant metastasis in early-stage non-small cell lung cancer treated with definitive radiation therapy: rethinking the role of positron emission tomography in personalizing treatment based on risk status. Int J Radiat Oncol Biol Phys 88(2):312–318CrossRefGoogle Scholar
- Schwartz DL, Ford E, Rajendran J, Yueh B, Coltrera MD, Virgin J, Anzai Y, Haynor D, Lewellyn B, Mattes D, Meyer J, Phillips M, Leblanc M, Kinahan P, Krohn K, Eary J, Laramore GE (2005) FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 61(1):129–136CrossRefGoogle Scholar
- Seethala RR, Stenman G (2017) Tumours of the salivary gland. In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ (eds) World Health Organization (WHO) classification of head and neck tumours, 4th edn. IARC Press, LyonGoogle Scholar