title: Prognostic value of preoperative intratumoral FDG uptake heterogeneity in early stage uterine cervical cancer.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyun Hoon
authors.identifier: http://orcid.org/0000-0002-5158-7492
authors.initials: HH
authors.lastname: Chung
authors.affiliation: Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.|Department of Molecular Medicine and Biopharmaceutical Science, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
authors.forename: Seo Young
authors.identifier: http://orcid.org/0000-0003-2431-3397
authors.initials: SY
authors.lastname: Kang
authors.affiliation: Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.|Department of Molecular Medicine and Biopharmaceutical Science, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
authors.forename: Seunggyun
authors.identifier: http://orcid.org/0000-0003-2016-1373
authors.initials: S
authors.lastname: Ha
authors.affiliation: Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jae-Weon
authors.identifier: http://orcid.org/0000-0003-1835-9436
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Noh-Hyun
authors.initials: NH
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Song
authors.affiliation: Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. larrycheon@gmail.com.
authors.forename: Gi Jeong
authors.identifier: http://orcid.org/0000-0002-1360-5186
authors.initials: GJ
authors.lastname: Cheon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006019:Glycolysis; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000378:metabolism; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG PET/CT; Intratumoral; Population Characteristics; Uterine Cervical Neoplasms