Prognostic Importance of F-FDG Positron Emission Tomography in Uterine Cervical Cancer.

OBJECTIVES

The aim of this study was to evaluate the prognostic value of F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in the uterine cervix cancer patients.

METHODS

Thirty-two women (mean age: 52.7±12.6) who underwent F-FDG PET/CT for staging of uterine cervix cancer were retrospectively recruited for the study. Maximum standardized uptake value (SUV), SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors, lymph nodes, and distant metastases were calculated from F-FDG PET/CT images using the 40% threshold. Patients were divided into groups according to the presence of pelvic and para-aortic lymph node involvement on F-FDG PET/CT images. Life tables and Kaplan-Meier analyses were performed to compare the mean survival times of the different groups.

RESULTS

Primary tumor of 27 (84%) patients were F-FDG avid. The median SUV, SUV, MTV, and TLG of the primary tumors were 12.4, 6.1, 13.2 cm and 87.8 g/mL x cm respectively. Pathological uptake was detected in pelvic 14 (44%) patients and in paraaortic lymph nodes in 3 (10%) para-aortic lymph nodes. The median whole-body MTV and TLG were 21.7 cm and 91.1 g/mL x cm. Disease progression was detected in 7 (22%) patients within a median follow-up period of 20.9 (minimum-maximum: 3-82) months. The only significant PET parameter to predict progression-free survival was SUV in the primary tumor (p=0.038). During follow-up period 8 patients died. SUV (p=0.007), MTV (p=0.036), TLG (p=0.001) of primary tumor, presence of pathological uptake on pelvic or paraaortic lymph nodes (p=0.015), whole-body MTV (p=0.047) and whole-body TLG (p=0.001) were found statistically significant PET parameters to predict overall survival.

CONCLUSION

Metabolic parameters of primary tumors derived from F-FDG PET/CT images have prognostic importance for patients with uterine cervical carcinoma. In patients with metastatic disease, higher whole-body MTV and TLG are also associated with poor prognosis.