Comparison of the Prognostic Value of F-18 Pet Metabolic Parameters of Primary Tumors and Regional Lymph Nodes in Patients with Locally Advanced Cervical Cancer Who Are Treated with Concurrent Chemoradiotherapy

Abstract

ObjectiveThis study investigated the metabolic parameters of primary tumors and regional lymph nodes, as measured by pre-treatment F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) to compare the prognostic value for the prediction of tumor recurrence. This study also identified the most powerful parameter in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy.MethodsFifty-six patients who were diagnosed with cervical cancer with pelvic and/or paraaortic lymph node metastasis were enrolled in this study. Metabolic parameters including the maximum standardized uptake value (SUVmax), the metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors and lymph nodes were measured by pre-treatment F-18 FDG PET/CT. Univariate and multivariate analyses for disease-free survival (DFS) were performed using the clinical and metabolic parameters.ResultsThe metabolic parameters of the primary tumors were not associated with DFS. However, DFS was significantly longer in patients with low values of nodal metabolic parameters than in those with high values of nodal metabolic parameters. A univariate analysis revealed that nodal metabolic parameters (SUVmax, MTV and TLG), paraaortic lymph node metastasis, and post-treatment response correlated significantly with DFS. Among these parameters, nodal SUVmax (hazard ratio [HR], 4.158; 95% confidence interval [CI], 1.1–22.7; p = 0.041) and post-treatment response (HR, 7.162; 95% CI, 1.5–11.3; p = 0.007) were found to be determinants of DFS according to a multivariate analysis. Only nodal SUVmax was an independent pre-treatment prognostic factor for DFS, and the optimal cutoff for nodal SUVmax to predict progression was 4.7.ConclusionNodal SUVmax according to pre-treatment F-18 FDG PET/CT may be a prognostic biomarker for the prediction of disease recurrence in patients with locally advanced cervical cancer.

Prognosis-Predicting Model Based on [18F]fluorodeoxyglucose PET Metabolic Parameters in Locally Advanced Cervical Cancer Patients Treated with Concurrent Chemoradiotherapy: Multi-Center Retrospective Study

“…In this study, the quantitative metabolic parameter for regional lymph nodes, i.e., nodal SUVmax, and clinicopathological parameters were used to develop a prognostic risk model using nomograms. With a focus on 2-year DFS, our model found nodal SUVmax to be the highest-weighted negative prognostic factor, which corresponded with the findings of our previous studies [12,13]. With a focus on 5-year OS, young age was the highest-weighted negative prognostic factor.…”

“…Previously, we evaluated the 18 F-FDG PET/CT metabolic parameters for predicting tumor recurrence in locally advanced cervical cancer treated with CCRT. Among SUVmax, metabolic tumor volume, total lesion glycolysis of the primary tumor, regional lymph node, and whole body, and tumor heterogeneity, the SUVmax of regional lymph node was the most powerful biomarker for predicting tumor recurrence in locally advanced cervical cancer treated with CCRT [12,13]. Previous 18 F-FDG PET-based prognostic nomograms included lymph node status as a prognostic factor; however, only lymph node level was included [19].…”

“…For this study, we enrolled 270 patients with biopsy-confirmed cervical cancer treated with CCRT between November 2004 and November 2016 from three institutions (Kyungpook National University Chilgok Hospital, Daegu Catholic University Medical Center, and Yeungnam University Medical Center). Some of the enrolled patients at Kyungpook National University Chilgok Hospital included patients who had been included in previous studies [12]. Retrospective data collection and analysis were approved by the Institutional Review Boards of each institution.…”

“…Moreover, radiomics from diffusion-weighted imaging-magnetic resonance imaging and 18 F-FDG PET/CT were independent predictors of recurrence in locally advanced cervical cancer treated with CCRT [11]. Previously, we have attempted to discover a biomarker for predicting tumor recurrence using pre-treatment 18 F-FDG PET/CT in locally advanced cervical cancers treated with CCRT, and found only nodal maximum standardized uptake value (SUVmax) to be the most powerful biomarker for predicting tumor recurrence [12]. Moreover, we evaluated the prognostic value of intratumoral metabolic heterogeneity on 18 F-FDG PET/CT, but it did not show superiority over traditional metabolic parameters [13].…”

The prognostic value of preoperative FDG-PET/CT metabolic parameters in cervical cancer patients

“…In another recent study, Crivellaro et al (2012) prospectively analysed 69 cervical cancer patients with FIGO stage IB1-IIA and found that SUVmax of the primary tumor did not predict recurrence in early stage cervical cancer. Moreover, a recent study demonstrated that SUV max of the primary tumor was not found to be predictive of overall survival (P = 0.233) (Chong et al, 2015). Hence, findings from these reports and the present study illustrate that although tumour SUVmax is widely used as a prognostic marker for several malignancies, it has obvious limitations that may be due to several factors.…”