title: Prognostic Value of the Sum of Metabolic Tumor Volume of Primary Tumor and Lymph Nodes Using 18F-FDG PET/CT in Patients With Cervical Cancer.
abstract: This is an observational study to determine the most relevant parameter of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting recurrence in cervical cancer. Fifty-six patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IVA cervical cancer who underwent pretreatment ¹⁸F-FDG PET/CT were enrolled. PET parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of both primary tumor and pelvic and/or para-aortic lymph nodes were analyzed. SUVmax-S was defined as the sum of the SUVmax of primary tumor and the higher SUVmax of either pelvic or para-aortic lymph nodes. MTV-S was defined as the sum of the MTV of primary tumor and pelvic and para-aortic lymph nodes. TLG-S was calculated in the same way as MTV-S. We evaluated the relationship between these PET parameters and recurrence-free survival (RFS). Univariate analysis revealed that higher FIGO stage (hazard ratio [HR] = 5.61, 95% confidence interval [CI]: 1.68-18.68, P = 0.005), lymph node metastasis (HR = 3.42, 95% CI: 1.08-10.84, P = 0.037), MTV of primary tumor >47.81 cm³ (HR = 6.20, 95% CI: 1.35-28.48, P = 0.019), TLG of primary tumor >215.02 (HR = 11.82, 95% CI: 1.52-91.96, P = 0.018), MTV-S > 59.01 cm³ (HR = 8.24, 95% CI: 1.80-37.77, P = 0.007), and TLG-S > 224.15 (HR =  13.09, 95% CI: 1.68-101.89, P = 0.014) were associated with RFS. In multivariate analysis, FIGO stage (HR = 4.87, 95% CI: 1.38-17.18, P = 0.014) and MTV-S > 59.01 cm³ (HR = 7.37, 95% CI: 1.54-35.16, P = 0.012) were determined to be independent predictive factors for RFS. Our preliminary results reveal that MTV-S is an independent prognostic factor for RFS in patients with cervical cancer treated by definitive chemoradiotherapy.
authors.affiliation: From the Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University (JHH, KJM, JKL); Department of Obstetrics and Gynecology, Cheil General Hospital and Women Healthcare Center, Dankook University College of Medicine (KAS); Department of Obstetrics and Gynecology, Hallym University Hangang Sacred Heart Hospital (USJ); Department of Nuclear Medicine, Anam Hospital, College of Medicine, Korea University (SK) and Department of Nuclear Medicine, Guro Hospital, College of Medicine, Korea University, Seoul, Korea (JSE).
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Hong
authors.forename: Kyung Jin
authors.initials: KJ
authors.lastname: Min
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Lee
authors.forename: Kyeong A
authors.initials: KA
authors.lastname: So
authors.forename: Un Suk
authors.initials: US
authors.lastname: Jung
authors.forename: Sungeun
authors.initials: S
authors.lastname: Kim
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Eo
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D010388:Pelvis; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18