Prognostic significance of SUVmax and recurrence site on 18F-FDG PET/CT for overall survival prediction in recurrent hypopharyngeal cancer.

Abstract

Background: Recurrent hypopharyngeal carcinoma is associated with poor prognosis, yet the prognostic utility of maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT and its relation to recurrence site remain insufficiently characterized.

Objective: This study aimed to evaluate the association of SUVmax and recurrence site with overall survival (OS) in patients with recurrent hypopharyngeal carcinoma.

Methods: We retrospectively analyzed 69 patients with biopsy-confirmed recurrent hypopharyngeal carcinoma without distant metastasis treated at Viet Nam National Cancer Hospital between 2019 and 2024. PET/CT scans performed at recurrence diagnosis were used to measure SUVmax at the primary tumor and/or metastatic lymph nodes. Patients were classified by recurrence site: primary tumor only (Tumor-only), lymph nodes only (Node-only), or both (Tumor + Node). OS was assessed using Kaplan-Meier estimates and Cox proportional hazards regression, adjusted for age, ECOG, time to recurrence and type of treatment.

Results: Mean SUVmax was 12.3 ± 6.3. Patients with SUVmax > 12 had a median OS of 11.45 months (95% CI: 7.1-37.1) vs. 13.06 months (95% CI: 6.7-37.4) for SUVmax ≤ 12 (P < 0.01). Tumor + Node recurrence had a median OS of 11.2 months (95% CI: 6.8-37.4) vs. 13.6 months (95% CI: 6.7-34.5) for Tumor-only/Node-only (P = 0.009). In multivariate Cox regression, SUVmax > 12 (HR = 2.69, 95% CI: 1.37-5.30, P = 0.004), Tumor + Node recurrence (HR = 2.96, 95% CI: 1.45-6.06, P = 0.003), Non-surgery treatment (HR = 2.98, 95% CI: 1.23-7.23, P = 0.016) and ECOG PS ≥ 2 (HR = 2.22, 95% CI: 1.12-4.41, P = 0.023) independently predicted reduced OS.

Conclusion: Elevated SUVmax and combined tumor-nodal recurrence on PET/CT are significant predictors of reduced OS, supporting their role in prognostic stratification for recurrent hypopharyngeal carcinoma.