Akkus Yildirim Berna, Onal Cem, Erbay Gurcan, Cem Guler Ozan, Karadeli Elif, Reyhan Mehmet, Koc Zafer
a Department of Radiation Oncology , Baskent University Faculty of Medicine , Adana , Turkey.
b Department of Radiology , Baskent University Faculty of Medicine , Ankara , Turkey.
J Obstet Gynaecol. 2019 Feb;39(2):224-230. doi: 10.1080/01443615.2018.1492528. Epub 2018 Oct 24.
We analysed the correlation of F-fluorodeoxyglucose uptake into primary tumours using the maximum standardised uptake value (SUV) and the mean apparent diffusion coefficient (ADC) values in magnetic resonance imaging (MRI) with the clinical and pathological factors in patients with cervical cancer who were treated with concurrent chemoradiotherapy. The patients were stratified according to the primary tumour pre-treatment ADC and SUV cut-off values. There were significant correlations between the SUV of the primary tumour and tumour size, and the treatment response. The correlation between the ADC and FIGO stage, tumour size, and the lymph node metastasis was significant. The SUV was significantly and inversely correlated with the ADC for cervical cancer (r = -0.44, p <.001). In the multivariate analysis, the primary tumour ADC, treatment response and the lymph node metastasis emerged as significant independent predictors of both OS and DFS, and of the primary tumour SUV for DFS. Tumour size has a borderline significance for OS. High SUV and low ADC of the primary tumour are important predictive factors for identifying high-risk patients with cervical cancer who are treated with definitive chemoradiotherapy. These results point to a future role for the diffusion-weighted MRI and for F-fluorodeoxyglucose positron emission tomography, not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy for individual patients. Impact statement What is already known on this subject? A negative correlation between primary tumour SUV derived from positron emission tomography (PET/CT) and ADC derived from diffusion weighted magnetic resonance imaging (DW-MRI) in various cancer types and cervical cancer has been demonstrated. However, the prognostic value of primary tumour SUV and ADC in cervical cancer patients treated with definitive chemoradiotherapy is not well studied yet. What the results of this study add? The patients with high-risk features (larger tumours, extensive stage, lymph node metastasis) had higher primary tumour SUV and lower ADC values. Primary tumour ADC and lymph node metastasis emerged as significant independent predictors of both overall and disease-free survival. This study demonstrated that the functional biomarkers delivered from PET-CT and DW-MRI are important in predicting the treatment outcomes in the squamous cell carcinoma of cervix treated with definitive chemoradiotherapy, where clinical and radiological findings are very important, since these patients are not staged surgically. What are the implications of these findings for clinical practice and/or further research? Based on these findings, there may be a future role of DW-MRI and FDG/PET-CT not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy (ChRT) for individual patients.
我们分析了接受同步放化疗的宫颈癌患者中，利用最大标准化摄取值（SUV）评估的原发性肿瘤对F-氟脱氧葡萄糖的摄取情况，以及磁共振成像（MRI）中的平均表观扩散系数（ADC）值，与临床和病理因素之间的相关性。根据原发性肿瘤治疗前的ADC和SUV临界值对患者进行分层。原发性肿瘤的SUV与肿瘤大小及治疗反应之间存在显著相关性。ADC与国际妇产科联盟（FIGO）分期、肿瘤大小及淋巴结转移之间的相关性显著。宫颈癌的SUV与ADC呈显著负相关（r = -0.44，p <.001）。在多变量分析中，原发性肿瘤ADC、治疗反应及淋巴结转移是总生存期（OS）和无病生存期（DFS）以及DFS中原发性肿瘤SUV的显著独立预测因素。肿瘤大小对OS具有临界显著性。原发性肿瘤的高SUV和低ADC是识别接受根治性放化疗的高危宫颈癌患者的重要预测因素。这些结果表明，扩散加权MRI和F-氟脱氧葡萄糖正电子发射断层扫描不仅在宫颈癌分期中，而且在为个体患者选择放化疗后的辅助治疗方案方面，都具有未来的应用价值。影响声明关于该主题已知的信息是什么？在各种癌症类型及宫颈癌中，已证实正电子发射断层扫描（PET/CT）得出的原发性肿瘤SUV与扩散加权磁共振成像（DW-MRI）得出的ADC之间存在负相关。然而，原发性肿瘤SUV和ADC在接受根治性放化疗的宫颈癌患者中的预后价值尚未得到充分研究。本研究的结果补充了什么？具有高危特征（肿瘤较大、分期广泛、淋巴结转移）的患者原发性肿瘤SUV较高，ADC值较低。原发性肿瘤ADC和淋巴结转移是总生存期和无病生存期的显著独立预测因素。本研究表明，PET-CT和DW-MRI提供的功能生物标志物在预测接受根治性放化疗的宫颈鳞状细胞癌的治疗结果方面很重要，在这些患者中，临床和影像学检查结果非常重要，因为这些患者不进行手术分期。这些发现对临床实践和/或进一步研究有何意义？基于这些发现，DW-MRI和FDG/PET-CT不仅在宫颈癌分期中，而且在为个体患者选择放化疗（ChRT）后的辅助治疗方案方面，可能具有未来的应用价值。
