Analysis of Pretreatment FDG-PET SUV Parameters in Head-and-Neck Cancer: Tumor SUVmean Has Superior Prognostic Value

Purpose: To evaluate the prognostic significance of different descriptive parameters in head-and-neck cancer patients undergoing pretreatment [F-18] fluoro-D-glucose-positron emission tomography (FDG-PET) imaging. Patients and Methods: Head-and-neck cancer patients who underwent FDG-PET before a course of curative intent radiotherapy were retrospectively analyzed. FDG-PET imaging parameters included maximum (SUVmax), and mean (SUVmean) standard uptake values, and total lesion glycolysis (TLG). Tumors and lymph nodes were defined on co-registered axial computed tomography (CT) slices. SUVmax and SUVmean were measured within these anatomic regions. The relationships between pretreatment SUVmax, SUVmean, and TLG for the primary site and lymph nodes were assessed using a univariate analysis for disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS). Kaplan-Meier survival curves were generated and compared via the log‒rank method. SUV data were analyzed as continuous variables. Results: A total of 88 patients was assessed. Two-year OS, LRC, DMFS, and DFS for the entire cohort were 85%, 78%, 81%, and 70%, respectively. Median SUVmax for the primary tumor and lymph nodes was 15.4 and 12.2, respectively. Median SUVmean for the primary tumor and lymph nodes was 7 and 5.2, respectively. Median TLG was 770. Increasing pretreatment SUVmean of the primary tumor was associated with decreased disease-free survival (p = 0.01). Neither SUVmax in the primary tumor or lymph nodes nor TLG was prognostic for any of the clinical endpoints. Patients with pretreatment tumor SUVmean that exceeded the median value (7) of the cohort demonstrated inferior 2-year DFS relative to patients with SUVmean ≤ the median value of the cohort, 58% vs. 82%, respectively, p = 0.03. Conclusion: Increasing SUVmean in the primary tumor was associated with inferior DFS. Although not routinely reported, pretreatment SUVmean may be a useful prognostic FDG-PET parameter and should be further evaluated prospectively.