Prognostic Value of FDG-PET/CT Findings in Mucosal Melanoma of the Head and Neck Treated with Carbon Ion Radiotherapy
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Objective To investigate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) in patients with mucosal melanoma of the head and neck (MMHN) treated with carbon ion radiotherapy (CIRT). Methods This single-center retrospective study included patients with MMHN who underwent CIRT and FDG-PET/CT. Correlations of pre-treatment FDG-PET/CT-derived parameters, including the maximum standardized uptake variable (SUVmax), metabolic tumor volume (MTV) with a 50% threshold, total lesion glycolysis (TLG), bone marrow-to-liver ratio (BLR), and spleen-to-liver ratio (SLR), with clinical parameters and prognosis were statistically analyzed. Results A total of 32 patients with MMHN were enrolled (median age, 72.5 years). The tumor stages were distributed as follows: T3, 17 patients; T4a, 14 patients; and T4b, one patient. The median total observation period was 22.6 months, the median overall survival (OS) was 21.6 months, and the median progression-free survival (PFS) was 11.5 months. Thirteen patients (40.6%) died, 10 (31.3%) experienced local recurrence, and 19 (59.4%) had distant metastases during the observation period. The 1-year survival rate was 78.1% and the 3-year survival rate was 62.5%. FDG-PET/CT show pronounced positive uptake for all tumors (median SUVmax 13.80, range 2.74–32.99). SLR was high in patients with negative programmed death-ligand 1 (PD-L1) expression in the tumor ( p = 0.05). PFS was shorter in patients with a high MTV ( p = 0.018). In multivariate analysis, MTV was an independent prognostic factor for PFS (hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.065–6.345; p = 0.036). MTV and TLG were not predictive of OS in the univariate analysis. Conclusion FDG-PET/CT showed a strong positive uptake for MMHN. FDG-PET/CT-derived imaging parameters may be significant prognostic biomarkers for predicting tumor progression in patients with MMHN.
