Prognostic value of 18F-FDG PET/CT functional parameters in patients with head and neck cancer: a meta-analysis

Purpose We performed this meta-analysis to evaluate the prognostic value of maximum of standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) in patients with head and neck cancer. Methods Articles including prognostic value of PET/CT were searched in PubMed and subsequently analyzed. The primary outcome of interest was event-free survival, and the secondary outcome of interest was overall survival. Statistical analysis was performed using hazard ratio (HR) and odds ratio. Review manager 5.3 was used to generate the eligible data. Results A total of 28 studies with 1871 patients were included in this meta-analysis. The pooled HR for event-free survival was 1.84 [95% confidence interval (CI): 1.43-2.37, P<0.00001] with SUVmax, 3.38 (95% CI: 2.68-4.27, P<0.00001) with MTV, and 3.55 (95% CI: 2.69-4.70, P<0.00001) with TLG. Meanwhile, the pooled HR for overall survival was 1.07 (95% CI: 1.01-1.13, P=0.02) with SUVmax, 3.41 (95% CI: 2.33-4.97, P<0.00001) with MTV, and 2.75 (95% CI: 1.84-4.12, P<0.00001) with TLG. The results of analysis suggested that tumors with high volumetric parameters were associated with worse survival outcome. Conclusion Prognostic value of MTV and TLG is superior to SUVmax, and MTV and TLG can be used as prognostic biomarkers to predict outcome in patients with head and neck cancer.