J Gynecol Oncol.  2017 Jul;28(4):e43. 10.3802/jgo.2017.28.e43.

Prognostic value of metabolic parameters determined by preoperative ¹⁸F-FDG PET/CT in patients with uterine carcinosarcoma

• Lee HJ
• Lee JJ
• Park JY
• Kim JH
• Kim YM
• Kim YT
• Nam JH

• KMID: 2413430
• DOI: http://doi.org/10.3802/jgo.2017.28.e43

Abstract

OBJECTIVE
To evaluate the prognostic value of metabolic parameters measured by preoperative ¹â¸F-fluorodeoxyglucose (¹â¸F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with uterine carcinosarcoma (UCS).
METHODS
Data of 55 eligible patients with UCS who underwent preoperative ¹â¸F-FDG PET/CT and surgical staging were analyzed retrospectively. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTVâ‚‚.â‚…), and total lesion glycolysis (TLGâ‚‚.â‚…) of the primary tumors were measured using a SUV threshold of 2.5. The optimal cutoff value of each parameter was determined by time-dependent receiver operating characteristic curve, and its impact on progression-free survival and overall survival was evaluated by Cox proportional hazards model.
RESULTS
During a median follow-up period of 29 (range, 1.5-109.4) months, 47.3% (26/55) of the patients experienced disease progression, and the disease-associated mortality rate was 43.6% (24/55). Univariate analysis determined that hazard ratios (HRs) for disease progression for SUVmax (≥8.33), MTV₂.₅ (≥63.92 mL), and TLG₂.₅ (≥396.16) were 1.930 (95% confidence interval [CI]=0.793-4.701), 3.264 (95% CI=1.466-7.268), and 2.692 (95% CI=1.224-5.924), respectively. And, HRs for death were 1.979 (95% CI=0.774-5.060), 2.764 (95% CI=1.217-6.274), and 2.721 (95% CI=1.198-6.182), respectively. While peritoneal cytology, histology, and tumor diameter were independent prognostic factors in multivariate analysis, MTV and TLG were not.
CONCLUSION
Though MTV and TLG of primary UCS were not independent predictors compared to surgically obtained data, MTV and TLG of primary UCS may provide useful information on prognosis especially in patients who are not able to undergo surgical staging.

Keyword

Carcinosarcoma; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Standardized Uptake Value; Metabolic Tumor Volume; Total Lesion Glycolysis

MeSH Terms

Adult
Aged
Carcinosarcoma/*diagnostic imaging/metabolism/secondary/surgery
Disease Progression
Disease-Free Survival
Female
Fluorodeoxyglucose F18
Follow-Up Studies
Glycolysis
Humans
Lymphatic Metastasis
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Peritoneal Neoplasms/*pathology/secondary
*Positron Emission Tomography Computed Tomography
Preoperative Period
ROC Curve
Radiopharmaceuticals
Retrospective Studies
Survival Rate
Tumor Burden
Uterine Cervical Neoplasms/*diagnostic imaging/metabolism/pathology/surgery
Radiopharmaceuticals
Fluorodeoxyglucose F18