AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026080092
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ORIGINAL RESEARCH ARTICLE

Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography metabolic characteristics in nasopharyngeal carcinoma with synchronous versus metachronous distant metastasis

Rong Huang1 ,  Yan Tang1 ,  Yun Zhang1*
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1 Department of PET/CT Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
EJMO, 026080092 https://doi.org/10.36922/EJMO026080092
Received: 22 February 2026 | Revised: 21 May 2026 | Accepted: 25 May 2026 | Published online: 24 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Prior studies seldom accounted for the timing of distant metastasis (DM) when linking tumor metabolism to metastatic potential. To fill this key research gap, this study investigates the metabolic heterogeneity among three DM subgroups: non-DM, metachronous DM (MDM), and synchronous DM (SDM).

Objectives: To explore the metabolic characteristics of DM-stratified nasopharyngeal carcinoma (NPC) cohorts.

Methods: This retrospective study included 281 patients with NPC who underwent pre-treatment fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. Metabolic parameters of the primary tumor (PT) and metastatic lymph node (MLN) were compared across three groups. Parameters associated with MDM and SDM were analyzed statistically.

Results: Demographic and clinical characteristics were comparable among groups (all p > 0.05). All PT and MLN metabolic parameters differed significantly across groups (all p < 0.05): PT parameters were higher in SDM/MDM than in non-DM (p < 0.05) without SDM–MDM differences, whereas MLN parameters increased sequentially with significant pairwise comparisons (all p < 0.05). Univariate regression revealed stronger associations between MLN parameters and MDM and SDM. Binary logistic regression identified distinct independent correlates: MDM was positively associated with PT glucose-normalized total lesion glycolysis and MLN glucose-normalized maximum standardized uptake value (SUVmax), and negatively with MLN mean SUV; SDM showed only positive correlates, including PT metabolic tumor volume, MLN metabolic tumor volume, and MLN lean body mass-normalized SUVmax.

Conclusion: This study systematically characterized metabolic heterogeneity across DM trajectories (non-DM, MDM, SDM). MLN metabolic parameters were more sensitive and robust than PT parameters, with distinct independent correlates for MDM and SDM.

Keywords
Nasopharyngeal carcinoma
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography
Metabolic heterogeneity
Metachronous distant metastasis
Synchronous distant metastasis
Funding
This study received funding from the special project of clinical research on truth-seeking by Jiangsu Cancer Hospital under grant number ZL202210.
Conflict of interest
The authors declare they have no competing interests.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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