Prognostic value of preoperative intratumoral FDG uptake heterogeneity in early stage uterine cervical cancer

Objectives Intratumoral fluorine-18 fluorodeoxyglucose ([¹⁸F]FDG) uptake heterogeneity reflects disease outcome. Here we investigated the prognostic value of intratumoural heterogeneity (IH) as determined using PET/CT in patients with uterine cervical cancer.

Methods Patients with FIGO stage IB to IIA uterine cervical cancer were imaged using [¹⁸F]FDG PET/CT before radical surgery. IH, maximum standardized uptake values (SUV_max), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were measured for each patient. Cox proportional hazard model was used to identify clinicopathological and imaging variables associated with progression-free survival (PFS).

Results We retrospectively reviewed the clinical data, treatment modalities and results of 48 eligible patients. Median PFS was 40 months (range, 3 to 43 months), with recurrence in five patients (10.4 %). IH at an SUV of 2.0 correlated with SUV_tumor (Pearson’s correlation coefficient (r) = 0.846, P < 0.001), TLG_tumor (r = 0.595, P < 0.001), MTV_tumor (r = 0.592, P < 0.001). Cox proportional hazard analysis revealed that recurrence was significantly associated with SUV_LN (P = 0.005), TLG_tumor (P = 0.007), IH (P = 0.023), SUV_tumor (P = 0.030) and FIGO stage (P = 0.037). Multivariate analysis showed that IH (P = 0.020; HR, 744.451; 95 % CI, 2.870-193104.582) and FIGO stage (P = 0.022; HR, 290.776; 95 % CI, 2.239-37754.972) were independent risk factors for recurrence.

Conclusions Preoperative IH as determined using FDG PET/CT was significantly associated with cervical cancer recurrence and may be a useful quantitative biomarker for disease prognostication before treatment.