Prognostic Implications of the SUVmax of Primary Tumors and Metastatic Lymph Node Measured by 18F-FDG PET in Patients With Uterine Cervical Cancer: A Meta-analysis.
OBJECTIVE
We conducted a meta-analysis to evaluate the prognostic value of the SUVmax measured in pretreatment primary lesions and metastatic lymph nodes (LNs) on 18F-FDG PET scans in patients with uterine cervical cancer.


METHODS
A systematic search of EMBASE and MEDLINE was performed using the keywords "positron emission tomography (PET)," "uterine cervical cancer," and "prognosis." Event-free survival and overall survival were evaluated as outcomes. The impact of SUVmax on survival was measured by the effect size of the hazard ratio (HR).


RESULTS
Fourteen eligible studies including 1150 patients were analyzed. Patients with a high primary SUVmax showed a worse prognosis, with an HR of 2.66 (95% confidence interval [CI], 1.90-3.74; P < 0.00001) for adverse events and an HR of 2.45 (95% CI, 1.74-3.45; P < 0.00001) for death. Patients with high SUVmax in metastatic pelvic LN (PLN) showed a worse prognosis, with an HR of 2.92 (95% CI, 1.94-4.39; P < 0.00001) for adverse events and an HR of 2.66 (95% CI, 1.60-4.43; P = 0.0002) for SUVmax in PLN for death. In addition, high SUVmax in metastatic para-aortic LN was associated with a worse prognosis, with an HR of 4.41 (95% CI, 2.32-8.38; P < 0.00001) for death.


CONCLUSIONS
Patients with uterine cervical cancer and a high SUVmax primary lesion, PLN, or para-aortic LN are at higher risk of adverse events or death.
From the *Department of Nuclear Medicine, Seoul National University Hospital; †Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine or College of Pharmacy; ‡Cancer Research Institute, Seoul National University Hospital; and §Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea; and ∥Department of Radiological Science, University of California at Irvine, CA.
Azmal
A
Sarker
Hyung-Jun
HJ
Im
Gi Jeong
GJ
Cheon
Hyun Hoon
HH
Chung
Keon Wook
KW
Kang
June-Key
JK
Chung
E Edmund
EE
Kim
Dong Soo
DS
Lee
D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
D019788:Fluorodeoxyglucose F18