Total lesion glycolysis: A possible new prognostic parameter in oral cavity squamous cell carcinoma

Chun Ta Liao*, Yasser G. Abd El-Hafez, Hosna M. Moustafa, Haytham F. Khalil, Tzu Chen Yen

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

54 Scopus citations


Objectives: We sought to determine potential prognostic value of total lesion glycolysis (TLG) calculated from combined positron emission tomography/computed tomography (PET/CT) in patients with oral cavity squamous cell carcinoma (OSCC). Materials and methods: We prospectively studied 126 patients with OSCC who underwent PET/CT before definitive treatment by radical surgery. The metabolic tumor volume (MTV) was calculated for the primary tumor according to an absolute standardized uptake value (SUV) of 3. TLG was calculated as MTV × the average SUV. The nodal SUVmax was also recorded. The median value of SUVmax and TLG were used to divide the patients into two categories (high and low). Patients were followed up until death or for at least 24 months from their surgery. Disease-free (DFS) and disease-specific survivals (DSS) were the main outcome measures. Results: The median TLG of the primary tumor (TTLG) was 71.4, and the median nodal SUVmax (NSUV) was 7.5. Patients with high TTLG (≥median) had a 2-year DFS of 52% whereas the DFS was 74% for those with a low TTLG (P = 0.007); the 2-year-DSS rates were 53% vs. 84%, respectively (P < 0.001). Similarly, patients with high NSUVmax (≥median) had a 2-year DFS of 42% vs. 70% for patients with a low NSUVmax (P = 0.001); the 2-year-DSS rates were 39% vs. 78%, respectively (P < 0.001). In multivariate analyses, TTLG, NSUVmax, and pathological nodal status were independent prognostic factors for the 2-year DSS. A 3-point prognostic scoring system was formulated based on the presence or absence of the independent factors. Patients with positive neck nodes, high NSUVmax, and high TTLG (score 3) had a 32-fold higher risk of cancer death compared with those lacking such risk factors (2-year-DSS = 26% vs. 97%, P < 0.001). Conclusion: Primary tumor TLG is an independent prognostic factor for cancer control and survival in patients with OSCC. A prognostic scoring system that includes primary tumor TLG, nodal SUVmax, and pathological neck status may be useful for risk stratification in this group of patients.

Original languageEnglish
Pages (from-to)261-268
Number of pages8
JournalOral Oncology
Issue number3
StatePublished - 03 2013
Externally publishedYes


  • Fluorodeoxyglucose
  • Oral cancer
  • Positron emission tomography computed tomography
  • Prognosis
  • Squamous cell carcinoma
  • Total lesion glycolysis
  • Tumor volume


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