Prognostic significance of bone marrow FDG uptake in patients with gynecological cancer

Sci Rep. 2021 Jan 26;11(1):2257. doi: 10.1038/s41598-021-81298-1.

Abstract

We investigated the prognostic significance and the underlying mechanism of increased bone marrow (BM) 2-(18F) fluoro-2-deoxy-D-glucose as a tracer (FDG)-uptake in patients with gynecological cancer. A list of patients diagnosed with cervical, endometrial, and ovarian cancer from January 2008 to December 2014 were identified. Then, through chart reviews, 559 patients who underwent staging by FDG-positron emission tomography (PET)/computed tomography (CT) and subsequent surgical resection were identified, and their clinical data were reviewed retrospectively. BM FDG-uptake was evaluated using maximum standardized uptake value (SUVmax) and BM-to-aorta uptake ratio (BAR). As a result, we have found that increased BAR was observed in 20 (8.7%), 21 (13.0%), 21 (12.6%) of cervical, endometrial, and ovarian cancer, respectively, and was associated with significantly shorter survival. Increased BAR was also closely associated with increased granulopoiesis. In vitro and in vivo experiments revealed that tumor-derived granulocyte colony-stimulating factor (G-CSF) was involved in the underlying causative mechanism of increased BM FDG-uptake, and that immune suppression mediated by G-CSF-induced myeloid-derived suppressor cells (MDSCs) is responsible for the poor prognosis of this type of cancer. In conclusion, increased BM FDG-uptake, as represented by increased BAR, is an indicator of poor prognosis in patients with gynecological cancer.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Aorta / metabolism
  • Bone Marrow / metabolism*
  • Cell Line, Tumor
  • Female
  • Fluorodeoxyglucose F18 / pharmacokinetics*
  • Genital Neoplasms, Female / diagnostic imaging
  • Genital Neoplasms, Female / metabolism*
  • Granulocyte Colony-Stimulating Factor / metabolism
  • Humans
  • Mice
  • Mice, Inbred C57BL
  • Middle Aged
  • Multivariate Analysis
  • Myeloid-Derived Suppressor Cells / metabolism
  • Positron Emission Tomography Computed Tomography
  • Prognosis
  • Progression-Free Survival
  • Rats

Substances

  • Fluorodeoxyglucose F18
  • Granulocyte Colony-Stimulating Factor