Prognostic value of FDG uptake by iliac lymph nodes in metastatic cervix cancer

Objectives The purpose of this study is to emphasize the metabolic parameters and their prognostic values on F-18 FDG PET-CT for staging of cervix cancer with iliac lymph node metastasis.

Methods Among the patients who underwent F-18 FDG PET-CT for staging of cervix cancer from 2008 to 2012, who showed metastatic iliac lymph nodes in iliac chains on PET-CT were included (n = 42). All the enrolled patients received concomitant chemoradiation therapy (CCRT) as the initial treatment, and were followed up at least for 3 months after the end of CCRT. We analyzed the metabolic parameters on staging PET-CT such as SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG), coefficient of variation (COV), of primary tumor, SUVmax of lymph nodes (SUVmaxLN) and their effect on disease progression with student t-test and multivariate logistic regression analysis. For the statistically significant parameter, Kaplan-Meier survival analysis was done to evaluate its effect on progression-free survival (PFS).

Results The SUVmean and diameter of primary tumor, and SUVmaxLN were significantly different between patients who experienced disease progression and who did not. On multivariate analysis, only the SUVmaxLN was found to be significant (p = 0.042, HR = 7.009, 95% CI: 1.076 - 45.632). The survival curves were significantly different (p = 0.011) by cutoff value 5.2, indicating the better prognosis in patients with SUVmaxLN < 5.2.

Conclusions The FDG uptake by lymph nodes was a significant prognostic factor in cervix cancer with iliac lymph node metastases.