Do clinical characteristics and metabolic markers detected on positron emission tomography/computerized tomography associate with persistent disease in patients with in-operable cervical cancer?
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The objective of this retrospective study was to evaluate the prognostic significance of volume-based metabolic markers of PET/CT along with clinical characteristics in patients with in-operable cervical carcinoma.
Fifty-eight patients with cervical carcinoma (stage IIB–IVB) underwent FDG PET/CT for pretreatment evaluation and included in this study. Patients were staged according to International Federation of Gynecology and Obstetrics [FIGO] system. After chemoradiation therapy, patients were evaluated for persistent disease (PD) by clinical examinations, smear tests, pelvic MRI and PET/CT. Based upon follow-up results, clinical characteristics (patient age, tumor histology, FIGO stage) and PET/CT findings such as presence of PET-positive pelvic/para-aortic lymph nodes (LN), metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake values (SUVmax) of tumor and lymph nodes were analyzed for disease persistence. Survival analysis for disease-free survival and overall survival was performed with Kaplan–Meier method using PET findings and clinical characteristics.
At the time of last follow-up (mean: 22 ± 12.6 months, range 6–48), 38 patients (65 %) had PD, 20 patients (35 %) had no evidence of disease (NED). Patient age, tumor histology, MTV, TLG and tumor SUVmax did not differ between groups. The frequency of PET-positive pelvic/para-aortic lymph nodes (84 vs. 60 %, p = 0.03), LN SUVmax (10.2 vs. 6.5, p = 0.02), and FIGO stage differed significantly between PD and NED groups. Cox proportional hazards model demonstrated advanced FIGO stage and the presence of PET-positive para-aortic LN were independent predictors for PD. Both disease-free survival and overall survival curves showed progressive worsening as the disease advanced, p = 0.015. PET LN status was the most important prognostic indicator for disease-free survival and overall survival. The worst outcome curves were detected for patients with PET-positive para-aortic lymph nodes among all patients, p = 0.03.
Advanced FIGO stage and the presence of FDG-avid para-aortic lymph nodes on pretreatment PET/CT are significant prognostic biomarkers for PD and decreased overall survival in patients with in-operable cervical carcinoma independent from MTV, TLG, tumor and lymph node SUVmax.
KeywordsCervical cancer PET/CT Metabolic tumor volume Total lesion glycolysis Prognosis SUVmax
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.WHO/ICO Information Center of HPV and Cervical Cancer (HPV Information Center). Human papillomavirus and related cancers in the world. Summary report 2010. http://www.who.int/hpvcentre/en/.
- 7.Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90–01. J Clin Oncol. 2004;22:872–80.PubMedCrossRefGoogle Scholar
- 12.Choi HJ, Roh JW, Seo SS, Lee S, Kim JY, Kim SK, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study. Cancer. 2006;106:914–22.PubMedCrossRefGoogle Scholar
- 17.Vansteenkiste JF, Stroobants SG, Dupont PJ, De Leyn PR, Verbeken EK, Deneffe GJ, et al. Prognostic importance of the standardized uptake value on (18)F-fluoro-2-deoxy-glucose-positron emission tomography scan in non-small-cell lung cancer: an analysis of 125 cases. Leuven Lung Cancer Group. J Clin Oncol. 1999;17:3201–6.PubMedGoogle Scholar
- 23.Chung MK, Jeong HS, Park SG, Jang JY, Son YI, Choi JY, et al. Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res. 2009;15:5861–8.PubMedCrossRefGoogle Scholar
- 28.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: cervical cancer, 06/02/09 update. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
- 35.Varia MA, Bundy BN, Deppe G, Mannel R, Averette HE, Rose PG, et al. Cervical carcinoma metastatic to paraaortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 1998;42:1015–23.PubMedCrossRefGoogle Scholar