Pelvic lymph node status assessed by 18F-fluorodeoxyglucose positron emission tomography predicts low-risk group for distant recurrence in locally advanced cervical cancer: a prospective study.
OBJECTIVE
To develop a prediction model to identify a low-risk group for distant recurrence in patients with locally advanced cervical cancer treated by concurrent chemoradiation.


METHODS
Prospectively, 62 patients with locally advanced cervical cancer were recruited as a training cohort. Clinical variables and parameters obtained from positron emission tomography (PET) and magnetic resonance imaging were analyzed by logistic regression. For the test set, 54 patients were recruited independently. To identify the low-risk group, negative likelihood ratio (LR) less than 0.2 was set to be a cutoff.


RESULTS
Among the training cohort, multivariate logistic analysis revealed that advanced International Federation of Gynecology and Obstetrics (FIGO) stage and a high serum squamous cancer cell (SCC) antigen level were significant risk factors (p=0.015 and 0.025, respectively). Using the two parameters, criteria to determine a low-risk subset for distant recurrence were postulated: (1) FIGO Stage IIB or less and (2) pretreatment SCC<2.4 (Model A). Positive pelvic node on PET completely predicted all cases with distant recurrence and thus was considered as another prediction model (Model B). In the test cohort, although Model A did not showed diagnostic performance, Model B completely predicted all cases with distant recurrence and showed a sensitivity of 100% with negative LR of 0. Across the training and test cohort (n=116), the false negative rate was 0 (95% confidence interval 0%-7.6%).


CONCLUSIONS
Positive pelvic node on PET is a useful marker in prediction of distant recurrence in patients with locally advanced cervical cancer who are treated with concurrent chemoradiation.
Kang
Sokbom
S
Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. sokbom@ncc.re.kr
Park
Jung-Yeol
JY
Lim
Myung-Chul
MC
Song
Yong-Joong
YJ
Park
Se-Hyun
SH
Kim
Seok-Ki
SK
Chung
Dae-Chul
DC
Seo
Sang-Soo
SS
Kim
Joo-Young
JY
Park
Sang-Yoon
SY
D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012306:Risk; D012680:Sensitivity and Specificity; D015843:Serpins / Q000097:blood; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D055815:Young Adult
D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D015843:Serpins; C051072:squamous cell carcinoma-related antigen; D019788:Fluorodeoxyglucose F18