Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan; and.
Biomedical Imaging Research Center, University of Fukui, Fukui, Japan.
J Nucl Med. 2021 May 10;62(5):636-642. doi: 10.2967/jnumed.120.244319. Epub 2020 Oct 2.
The purpose of this study was to evaluate the potential of 16α-F-fluoro-17β-estradiol (F-FES) PET to predict prognosis in patients with endometrial cancer (EC). In total, 67 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I-IV EC underwent F-FES and F-FDG PET/CT before treatment. The SUV of the primary tumor was compared with the clinical characteristics, and the relationships between SUV and progression-free survival (PFS) or overall survival were analyzed. F-FES SUV was significantly associated with stage, histology, lymphovascular space involvement (LVSI), and lymph node metastasis, and F-FDG SUV was significantly associated with stage, myometrial invasion, tumor size, and lymph node metastasis. Receiver-operating characteristic curve analysis revealed that F-FES SUV could significantly detect tumor progression and survival, with areas under the curve of 0.813 and 0.790, respectively, whereas F-FDG SUV could detect them with areas under the curve of 0.557 and 0.635, respectively. The Kaplan-Meier survival curve showed that patients with a low F-FES SUV had significantly poor PFS ( < 0.001) and overall survival ( = 0.001) compared with patients with a high SUV, whereas F-FDG showed no significant differences. In a subanalysis of 27 patients with a low risk of recurrence (FIGO stage IA endometrioid carcinoma [grade 1 or 2] without LVSI), those with a low F-FES SUV also had poorer PFS than those with a high SUV ( = 0.002). In multivariate analysis, an F-FES SUV of less than 2.63 ( 0.037; hazard ratio, 10.727; 95% CI, 1.16-99.35) and FIGO stages III and IV ( 0.042; hazard ratio, 8.838; 95% CI, 1.09-71.84) were significantly associated with PFS. A low F-FES for the primary tumor was strongly associated with prognostic factors of EC such as LVSI and lymph node metastasis, and a low F-FES SUV was an independent prognostic factor for PFS in patients with EC. These data suggest that pretreatment F-FES PET might be useful in determining the appropriate treatment for patients with EC.
本研究旨在评估 16α-F-氟-17β-雌二醇（F-FES）PET 预测子宫内膜癌（EC）患者预后的潜力。共 67 例国际妇产科联合会（FIGO）分期 I-IV 期 EC 患者在治疗前接受 F-FES 和 F-FDG PET/CT。比较原发肿瘤的 SUV 与临床特征，分析 SUV 与无进展生存期（PFS）或总生存期的关系。F-FES SUV 与分期、组织学、脉管间隙浸润（LVSI）和淋巴结转移显著相关，F-FDG SUV 与分期、肌层浸润、肿瘤大小和淋巴结转移显著相关。受试者工作特征曲线分析显示，F-FES SUV 可显著检测肿瘤进展和生存，曲线下面积分别为 0.813 和 0.790，而 F-FDG SUV 可检测到曲线下面积分别为 0.557 和 0.635。Kaplan-Meier 生存曲线显示，低 F-FES SUV 患者的 PFS（<0.001）和总生存期（=0.001）明显较差，而 F-FDG 则无显著差异。在 27 例复发风险低（FIGO 分期 IA 子宫内膜样癌[1 级或 2 级]且无 LVSI）患者的亚分析中，低 F-FES SUV 患者的 PFS 也明显低于高 SUV 患者（=0.002）。多变量分析显示，F-FES SUV 小于 2.63（=0.037；风险比，10.727；95%CI，1.16-99.35）和 FIGO 分期 III 和 IV（=0.042；风险比，8.838；95%CI，1.09-71.84）与 PFS 显著相关。原发肿瘤低 F-FES 与 EC 的 LVSI 和淋巴结转移等预后因素密切相关，低 F-FES SUV 是 EC 患者 PFS 的独立预后因素。这些数据表明，治疗前 F-FES PET 可能有助于确定 EC 患者的适当治疗。
