Preoperative PET/CT FDG standardized uptake value of pelvic lymph nodes as a significant prognostic factor in patients with uterine cervical cancer

  • Hyun Hoon Chung
  • Gi Jeong Cheon
  • Keon Wook Kang
  • Jae Weon Kim
  • Noh-Hyun Park
  • Yong Sang Song
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

Using integrated PET/CT, we evaluated the prognostic relevance in uterine cervical cancer of preoperative pelvic lymph node (LN) [18F]FDG uptake.

Methods

Patients with FIGO stage IB to IIA uterine cervical cancer were imaged with FDG PET/CT before radical surgery. We used Cox proportional hazards regression to examine the relationship between recurrence and the FDG maximum standardized uptake value (SUVmax) in the pelvic LN (SUVLN) on PET/CT.

Results

Clinical data, treatment modalities, and results in 130 eligible patients were reviewed. The median postsurgical follow-up was 34 months (range 6 to 109 months). Receiver operating characteristic analysis identified SUVLN 2.36 as the most significant cut-off value for predicting recurrence. SUVLN was correlated with SUVtumour (P = 0.002), primary tumour size (P = 0.004), and parametrial invasion (P = 0.013). Univariate analyses showed significant associations between recurrence and SUVLN (P = 0.001), SUVtumour (P = 0.007), pelvic LN metastasis (P = 0.002), parametrial invasion (P < 0.001), primary tumour size (P = 0.007), suspected LN metastasis on MRI (P = 0.024), and FIGO stage (P = 0.026). Multivariate analysis identified SUVLN (P = 0.013, hazard ratio, HR, 4.447, 95 % confidence interval, CI, 1.379 – 14.343) and parametrial invasion (P = 0.013, HR 6.728, 95 % CI 1.497 – 30.235) as independent risk factors for recurrence. Patients with SUVLN ≥2.36 and SUVLN <2.36 differed significantly in terms of recurrence (HR 15.20, P < 0.001).

Conclusion

Preoperative pelvic LN FDG uptake showed a strong significant association with uterine cervical cancer recurrence.

Keywords

FDG PET/CT SUV Pelvic lymph node Recurrence Cervical cancer 
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Notes

Acknowledgment

This work was supported by grant no 0420120750 (2012-1313) from the Seoul National University Hospital Research Fund.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Hyun Hoon Chung
    • 1
    • 4
  • Gi Jeong Cheon
    • 2
  • Keon Wook Kang
    • 2
  • Jae Weon Kim
    • 1
  • Noh-Hyun Park
    • 1
  • Yong Sang Song
    • 1
    • 3
  1. 1.Department of Obstetrics and Gynecology, Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Nuclear MedicineSeoul National University College of MedicineSeoulRepublic of Korea
  3. 3.WCU Biomodulation Major, Department of Agricultural Biotechnology, College of Agriculture and Life SciencesSeoul National UniversitySeoulRepublic of Korea
  4. 4.Department of Obstetrics and GynecologySeoul National University College of MedicineSeoulRepublic of Korea

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