Predicting Tumor Response to Neoadjuvant Chemotherapy Based on Pretreatment 18F-FDG PET/CT Parameters in Locally Advanced Oral Squamous Cell Carcinoma.

Abstract

Neoadjuvant chemotherapy (NC) is a pivotal preoperative treatment for oral squamous cell carcinoma (OSCC), but its efficacy varies among patients. This study aims to predict the efficacy of NC in patients with OSCC, facilitating precise pretreatment stratification. Methods: We retrospectively collected pretreatment ¹⁸F-FDG parameters and clinical characteristics from 89 patients with locally advanced OSCC, including primary (n = 62) and recurrent (n = 27) OSCC. MRI was used to evaluate treatment response and calculate the depth of response (DpR), assessing the correlations between these factors and NC efficacy. Results: In patients with primary OSCC, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were independent predictors of therapeutic response (P = 0.019 and P = 0.012, respectively). With an MTV cutoff of 11.7 cm³ and a TLG cutoff of 84.2, the areas under the receiver-operating-characteristic curve were 0.739 (P = 0.004) and 0.782 (P < 0.001), respectively. Pathologic grade, SUV, MTV, and TLG were independent predictors of DpR (P < 0.05). Pathologic grading, SUV_max normalized to lean body mass, and MTV accounted for 52.9% (coefficient of determination) of the variance in DpR without significant collinearity (variance inflation factor < 5.0). Among patients with recurrent OSCC, the SUV in NC responders was higher than that of nonresponders (P < 0.01). Conclusion: Pretreatment ¹⁸F-FDG PET/CT parameters could predict NC response and DpR in patients with OSCC.