Abstract
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Objectives The present study was to investigate the prognostic value of volume-based metabolic parameters by 18F-FDG PET in uterine cervical cancer compared with other prognostic parameters.
Methods Subjects were 73 patients initially diagnosed cervical cancer undergoing 18F-FDG PET between Nov. 2000 and Mar. 2008. Various metabolic or volume-based PET parameters of primary tumors including maximum and average standardized uptake value (SUVmax, SUVave), metabolic tumor volume (MTV), total lesion glycolysis (TLG) were measured in primary cervical tumors using a SUV of mediastinal blood pool for determining the boundary of tumor. Survival analysis for disease- or progression-free survival was performed by using a Kaplan-Meier method using PET parameters and other clinical variables including age, FIGO stage, treatment modality, histopathology, tumor size, presence of metastatic lymph node on PET or CT/MRI. For determining independent prognostic factors, Cox regression analysis was done.
Results Initial FIGO stage was I in 27, II in 32, and III/IV in 14 patients. Recurrence or disease progression occurred in 23 patients (31.5%). Mean clinical follow-up period was 44.7 ± 29.4 m. In univariate analysis, patients’ age (cut off = 57 y, p < 0.05), FIGO stage (p = 0.07), primary tumor size (cut off = 6.7 cm, p < 0.05), lymph node status on PET (negative vs. intrapelvic metastasis only vs. extrapelvic metastasis; p < 0.005), treatment methods (surgery only vs. surgery + other treatment vs. non-surgical treatment; p < 0.01), MTV (cut off = 82 cm3, p < 0.005), TLG (cut off = 7600, p = 0.005) were significant predictors for recurrence or progression. In multivariate analysis, both lymph node status on PET (hazard ratio = 2.511, p = 0.001) and TLG (hazard ratio = 2.620, p < 0.05) were independent prognostic factors for predicting recurrence.
Conclusions In uterine cervical cancer, TLG is a significant independent prognostic factor for disease- or progression-free survival along with lymph node status on 18F-FDG PET