J Gynecol Oncol.  2016 Mar;27(2):e15. 10.3802/jgo.2016.27.e15.

Prognostic value of preoperative intratumoral FDG uptake heterogeneity in early stage uterine cervical cancer

• Chung HH
• Kang SY
• Ha S
• Kim JW
• Park NH
• Song YS
• Cheon GJ

• KMID: 2360245
• DOI: http://doi.org/10.3802/jgo.2016.27.e15

Abstract

OBJECTIVE
We investigated the prognostic value of intratumoral [18F]fluorodeoxyglucose (FDG) uptake heterogeneity (IFH) derived from positron emission tomography/computed tomography (PET/CT) in patients with cervical cancer.
METHODS
Patients with uterine cervical cancer of the International Federation of Obstetrics and Gynecology (FIGO) stage IB to IIA were imaged with [18F]FDG PET/CT before radical surgery. PET/CT parameters such as maximum and average standardized uptake values (SUV(max) and SUV(avg)), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and IFH were assessed. Regression analyses were used to identify clinicopathological and imaging variables associated with progression-free survival (PFS).
RESULTS
We retrospectively reviewed clinical data of 85 eligible patients. Median PFS was 32 months (range, 6 to 83 months), with recurrence observed in 14 patients (16.5%). IFH at an SUV of 2.0 was correlated with primary tumor size (p<0.001), SUV(tumor) (p<0.001), MTV(tumor) (p<0.001), TLG(tumor) (p<0.001), depth of cervical invasion (p<0.001), and negatively correlated with age (p=0.036). Tumor recurrence was significantly associated with TLG(tumor) (p<0.001), MTV(tumor) (p=0.001), SUV(LN) (p=0.004), IFH (p=0.005), SUV(tumor) (p=0.015), and FIGO stage (p=0.015). Multivariate analysis identified that IFH (p=0.028; hazard ratio, 756.997; 95% CI, 2.047 to 279,923.191) was the only independent risk factor for recurrence. The Kaplan-Meier survival graphs showed that PFS significantly differed in groups categorized based on IFH (p=0.013, log-rank test).
CONCLUSION
Preoperative IFH was significantly associated with cervical cancer recurrence. [18F]FDG based heterogeneity may be a useful and potential predicator of patient recurrence before treatment.

Keyword

FDG PET/CT; Intratumoral; Population Characteristics; Uterine Cervical Neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell/metabolism/*radionuclide imaging/secondary
Disease-Free Survival
Female
Fluorodeoxyglucose F18/*pharmacokinetics
Glycolysis
Humans
Middle Aged
Multimodal Imaging
Neoplasm Invasiveness
Neoplasm Recurrence, Local/metabolism/radionuclide imaging
Neoplasm Staging
*Positron-Emission Tomography
Predictive Value of Tests
Radiopharmaceuticals/*pharmacokinetics
Retrospective Studies
Tomography, X-Ray Computed
Tumor Burden
Uterine Cervical Neoplasms/metabolism/pathology/*radionuclide imaging
Fluorodeoxyglucose F18
Radiopharmaceuticals