Prognostic value of metabolic tumor volume measured by FDG-PET/CT in patients with cervical cancer.
OBJECTIVE
To determine if preoperative metabolic tumor volume (MTV) measured by integrated (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (FDG-PET/CT) imaging has prognostic value in patients with cervical cancer treated primarily with radical hysterectomy.


METHODS
Patients with FIGO stage IB to IIA cervical cancer were imaged with FDG-PET/CT before radical surgery. MTV was measured from attenuation-corrected FDG-PET/CT images using a standard uptake value (SUV)-based automated contouring program. We evaluated the relationship of MTV to disease-free survival (DFS).


RESULTS
A total of 63 patients were included in the study. The cut-off value for predicting recurrence was determined using a receiver operating characteristic (ROC) curve. MTV in this study was found to be correlated with lymph node (LN) metastasis, parametrium (PM) involvement, FIGO stage, and SUV(max). In univariate analysis, MTV≥23.4 mL (HR 1.017, 95% confidence interval (CI) 1.005-1.029, P=0.004), SUV(max)≥9.5 (HR 5.198, 95% CI 1.076-25.118, P=0.04), LN metastasis (HR 12.338, 95% CI 1.541-98.813, P=0.018), PM involvement (HR 14.274, 95% CI 1.785-114.149, P=0.012), and lymphovascular space invasion (HR 8.871, 95% CI 1.104-71.261, P=0.04), were related to DFS. In multivariate analyses, age (HR 0.748, 95% CI 0.587-0.952, P=0.018) and MTV≥23.4 mL (HR 49.559, 95% CI 1.257-1953.399, P=0.037) were determined to be independent prognostic factors of DFS.


CONCLUSIONS
Preoperative MTV is an independent prognostic factor for DFS in patients with cervical cancer treated by radical surgery.
Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Hyun Hoon
HH
Chung
Jae Weon
JW
Kim
Kyung Hee
KH
Han
Jae Seon
JS
Eo
Keon Wook
KW
Kang
Noh-Hyun
NH
Park
Yong-Sang
YS
Song
June-Key
JK
Chung
Soon-Beom
SB
Kang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18