Prognostic Value of the Sum of Metabolic Tumor Volume of Primary Tumor and Lymph Nodes Using 18F-FDG PET/CT in Patients With Cervical Cancer

Medicine (Baltimore). 2016 Mar;95(9):e2992. doi: 10.1097/MD.0000000000002992.

Abstract

This is an observational study to determine the most relevant parameter of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting recurrence in cervical cancer. Fifty-six patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IVA cervical cancer who underwent pretreatment ¹⁸F-FDG PET/CT were enrolled. PET parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of both primary tumor and pelvic and/or para-aortic lymph nodes were analyzed. SUVmax-S was defined as the sum of the SUVmax of primary tumor and the higher SUVmax of either pelvic or para-aortic lymph nodes. MTV-S was defined as the sum of the MTV of primary tumor and pelvic and para-aortic lymph nodes. TLG-S was calculated in the same way as MTV-S. We evaluated the relationship between these PET parameters and recurrence-free survival (RFS). Univariate analysis revealed that higher FIGO stage (hazard ratio [HR] = 5.61, 95% confidence interval [CI]: 1.68-18.68, P = 0.005), lymph node metastasis (HR = 3.42, 95% CI: 1.08-10.84, P = 0.037), MTV of primary tumor >47.81 cm³ (HR = 6.20, 95% CI: 1.35-28.48, P = 0.019), TLG of primary tumor >215.02 (HR = 11.82, 95% CI: 1.52-91.96, P = 0.018), MTV-S > 59.01 cm³ (HR = 8.24, 95% CI: 1.80-37.77, P = 0.007), and TLG-S > 224.15 (HR = 13.09, 95% CI: 1.68-101.89, P = 0.014) were associated with RFS. In multivariate analysis, FIGO stage (HR = 4.87, 95% CI: 1.38-17.18, P = 0.014) and MTV-S > 59.01 cm³ (HR = 7.37, 95% CI: 1.54-35.16, P = 0.012) were determined to be independent predictive factors for RFS. Our preliminary results reveal that MTV-S is an independent prognostic factor for RFS in patients with cervical cancer treated by definitive chemoradiotherapy.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / metabolism
  • Adenocarcinoma / mortality
  • Adult
  • Aged
  • Aged, 80 and over
  • Aorta
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / metabolism
  • Carcinoma, Squamous Cell / mortality
  • Female
  • Fluorodeoxyglucose F18
  • Follow-Up Studies
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / metabolism
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Middle Aged
  • Multimodal Imaging
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / metabolism
  • Neoplasm Recurrence, Local / mortality
  • Pelvis
  • Positron-Emission Tomography*
  • Prognosis
  • Radiopharmaceuticals
  • Retrospective Studies
  • Survival Analysis
  • Tomography, X-Ray Computed*
  • Tumor Burden
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / metabolism
  • Uterine Cervical Neoplasms / mortality

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18