Guler Ozan Cem, Torun Nese, Yildirim Berna Akkus, Onal Cem
1 Department of Radiation Oncology, Karadeniz Technical University Faculty of Medicine , Trabzon , Turkey.
2 Department of Nuclear Medicine, Baskent University Faculty of Medicine , Adana , Turkey.
Br J Radiol. 2018 Apr;91(1084):20170552. doi: 10.1259/bjr.20170552. Epub 2018 Jan 10.
To evaluate the prognostic significance of metabolic parameters derived from fludeoxyglucose (FDG) positron emission tomography (PET)/CT, in cervical cancer patients treated with concurrent chemoradiotherapy.
We retrospectively reviewed medical records from 129 biopsy-proven non-metastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at our department. Correlation between metabolic parameters and tumour characteristics was evaluated. Prognostic factors for survival, local control and distant metastasis were analysed.
The median follow up for all patients and surviving patients was 30.0 months (range, 3.7-94.7 months) and 50.5 months (range, 14.5-94.7 months), respectively. The 2- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 68 42, 54 and 38%, respectively. The maximum standardized uptake value (SUV), SUV, metabolic tumour volume (MTV) and total lesion glycolysis were significantly higher in patients with larger tumours (>4 cm) and partial regression or progressive disease after definitive treatment compared to patients with smaller tumour (≤4 cm) and post-treatment complete response. On univariate analysis, stage, lymph node metastasis, tumour size >4 cm, SUV, MTV, SUV and total lesion glycolysis were prognostic factors for OS and DFS. On multivariate analysis, only larger tumour and presence of lymph node metastasis were significant prognostic factors for both OS and DFS. Additionally, extensive stage was a significant prognosticator for DFS.
Although, metabolic parameters derived from FDG-PET/CT had a prognostic significance in univariate analysis, the significance was lost in multivariate analysis where tumour stage, size and lymph node status were the only independent parameters. Advances in knowledge: The clinical benefit of using FDG-PET/CT metabolic parameters to evaluate the high-risk patients among cervical cancer patients and to eventually change patient management still needs further clarification.
评估氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT得出的代谢参数在接受同步放化疗的宫颈癌患者中的预后意义。
我们回顾性分析了在我院接受外照射放疗和腔内近距离放疗的129例经活检证实为非转移性宫颈癌患者的病历。评估代谢参数与肿瘤特征之间的相关性。分析生存、局部控制和远处转移的预后因素。
所有患者和存活患者的中位随访时间分别为30.0个月（范围3.7 - 94.7个月）和50.5个月（范围14.5 - 94.7个月）。2年和5年总生存率（OS）和无病生存率（DFS）分别为68%、42%、54%和38%。与肿瘤较小（≤4 cm）且治疗后完全缓解的患者相比，肿瘤较大（>4 cm）且根治性治疗后部分缓解或疾病进展的患者的最大标准化摄取值（SUV）、SUV、代谢肿瘤体积（MTV）和总病变糖酵解显著更高。单因素分析中，分期、淋巴结转移、肿瘤大小>4 cm、SUV、MTV、SUV和总病变糖酵解是OS和DFS的预后因素。多因素分析中，仅肿瘤较大和存在淋巴结转移是OS和DFS的显著预后因素。此外，广泛期是DFS的显著预后因素。
尽管FDG - PET/CT得出的代谢参数在单因素分析中有预后意义，但在多因素分析中该意义丧失，其中肿瘤分期、大小和淋巴结状态是仅有的独立参数。知识进展：使用FDG - PET/CT代谢参数评估宫颈癌高危患者并最终改变患者管理的临床益处仍需进一步阐明。
