Abstract
The purpose of this study was to evaluate the potential of 16α-[18F]-fluoro-17β-estradiol (18F-FES) PET to predict prognosis in patients with endometrial cancer (EC). Methods: A total of 67 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I–IV endometrial cancer underwent 18F-FES and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) before treatment. The mean standardized uptake value (SUV) of the primary tumor was compared with the clinical characteristics, and the relationships between SUV and progression-free survival (PFS) or overall survival (OS) were analyzed. Results: 18F-FES SUV significantly associated with stage, histology, lymphovascular space involvement (LVSI), and lymph node metastasis; and 18F-FDG SUV significantly associated with stage, myometrial invasion, tumor size, and lymph node metastasis. Receiver-operating characteristic curve analysis revealed that 18F-FES SUV could significantly detect tumor progression and survival with area under the curve (AUC) of 0.813 and 0.790, respectively; whereas 18F-FDG SUV could detect them with AUC of 0.557 and 0.635. The Kaplan–Meier survival curve showed that patients with low 18F-FES SUV had significantly poor PFS (p<0.001) and OS (P = 0.001) compared with patients with high SUV, whereas 18F-FDG showed no significant differences. In a sub-analysis of 27 patients with low risk of recurrence (FIGO stage IA endometrioid carcinoma [grade 1 or 2] without LVSI, those with low 18F-FES SUV also had poorer PFS) than those with high SUV (P = 0.002). In multivariate analysis, 18F-FES SUV <2.63 (P = 0.037, hazard ratio (HR) 10.727, 95% confidence interval (CI) 1.16–99.35), and FIGO stages III and IV (P = 0.042, HR 8.838, 95%CI 1.09–71.84) were significantly associated with PFS. Conclusion: Low pretreatment 18F-FES SUV of the primary tumor associated strongly with prognostic factors of EC such as LVSI and lymph node metastasis, and low 18F-FES SUV was an independent prognostic factor for PFS in patients with EC. These data suggest that pretreatment 18F-FES PET might be useful in determining the appropriate treatment for patients with EC.
- Molecular Imaging
- Oncology: GYN
- PET/CT
- 16α-[18F]-fluoro-17β-estradiol (FES)
- 18F-fluorodeoxyglucose (FDG)
- endometrial cancer
- positron emission tomography/computed tomography (PET/CT)
- prognostic marker
- Copyright © 2020 by the Society of Nuclear Medicine and Molecular Imaging, Inc.