[Predictive value of ¹⁸F-FDG PET/CT metabolic parameters for survival in patients with recurrent tongue squamous cell carcinoma receiving nonsurgical treatment].

Authors

Xiaohuang Yang, Kai Zheng, Hui Cao, Lei Xue, Xiaoping Yu, Hui Ye

Published in

Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. Volume 51. Issue 6. Pages 1224-1237. Jun 28, 2026.

Abstract

Patients with recurrent tongue squamous cell carcinoma (RTSCC) receiving nonsurgical treatment have a poor prognosis. This study aims to identify independent factors associated with survival in these patients and to evaluate the effects of treatment response on survival outcomes.
Patients with RTSCC who received nonsurgical treatment at Hunan Cancer Hospital between January 2017 and July 2024 were retrospectively enrolled. Pretreatment metabolic parameters derived from ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) were measured, including the maximum, mean, and peak standardized uptake values corrected for lean body mass (SULmax, SULmean, and SULpeak), the lesion-to-mediastinal blood-pool SULmean ratio (SULR), whole-body total metabolic tumor volume (MTV), and whole-body total lesion glycolysis (TLG). Baseline clinical characteristics, pathological features from the initial surgery, and treatment modalities after recurrence were also collected. Treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), or the immune Response Evaluation Criteria in Solid Tumors (iRECIST), and patients were classified into response and nonresponse groups. Progression-free survival (PFS) and overall survival (OS) were followed. Univariate and multivariate Cox regression analyses were performed to identify independent factors associated with PFS and OS. Two sensitivity analyses, restricted to patients scanned using the same scanner model and to those who underwent whole-body scanning, respectively, were conducted to assess the robustness of the primary findings. Model performance was evaluated using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves, and calibration curves. Time-dependent Cox regression and landmark analyses were used to assess the effects of treatment response on survival.
A total of 93 patients with RTSCC were included. The follow-up duration ranged from 2 to 81 months, with a median of 38 months. Disease progression occurred in 72 patients, and 66 patients died. PFS ranged from 1 to 81 months, with a median of 4 months, whereas OS ranged from 2 to 81 months, with a median of 11 months. In the primary analysis, radiotherapy after recurrence was an independent protective factor for PFS (HR=0.461, 95% CI 0.233 to 0.912, P=0.026). This association remained significant in the sensitivity analysis restricted to patients scanned using the same scanner model (P=0.032), but was not significant in the analysis restricted to patients who underwent whole-body scanning (P=0.159). The corrected C-index of the PFS prediction model was 0.609, indicating limited predictive performance for 3- and 6-month PFS. In the analysis of OS, the natural logarithm of MTV [ln(MTV); HR=1.299, 95% CI 1.092 to 1.546, P=0.003] and radiotherapy after recurrence (HR=0.377, 95% CI 0.180 to 0.790, P=0.010) were independent predictors of OS. Both sensitivity analyses supported the robustness of these findings. The corrected C-index of the OS prediction model was 0.663, indicating moderate discrimination for 1- and 2-year OS. Time-dependent Cox regression analysis showed that treatment response was not significantly associated with PFS (HR=0.618, 95% CI 0.327 to 1.167, P=0.138; C-index=0.517), whereas treatment response had a significant protective effect on OS (HR=0.340, 95% CI 0.196 to 0.590, P<0.001; C-index=0.620). The 2-month landmark analysis showed that both PFS and OS were significantly longer in the response group than in the nonresponse group (both P<0.001).
Whole-body total MTV and radiotherapy after recurrence have potential prognostic value for OS in patients with RTSCC receiving nonsurgical treatment. The protective association between radiotherapy after recurrence and PFS requires further validation. Patients who achieved a treatment response had better OS than those who did not respond.

PMID:
42702383
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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