Prognostic value of metabolic tumor volume measured by FDG-PET/CT in patients with cervical cancer

Abstract

ObjectiveTo determine if preoperative metabolic tumor volume (MTV) measured by integrated 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (FDG-PET/CT) imaging has prognostic value in patients with cervical cancer treated primarily with radical hysterectomy. MethodsPatients with FIGO stage IB to IIA cervical cancer were imaged with FDG-PET/CT before radical surgery. MTV was measured from attenuation-corrected FDG-PET/CT images using a standard uptake value (SUV)-based automated contouring program. We evaluated the relationship of MTV to disease-free survival (DFS). ResultsA total of 63 patients were included in the study. The cut-off value for predicting recurrence was determined using a receiver operating characteristic (ROC) curve. MTV in this study was found to be correlated with lymph node (LN) metastasis, parametrium (PM) involvement, FIGO stage, and SUVmax. In univariate analysis, MTV≥23.4mL (HR 1.017, 95% confidence interval (CI) 1.005–1.029, P=0.004), SUVmax≥9.5 (HR 5.198, 95% CI 1.076–25.118, P=0.04), LN metastasis (HR 12.338, 95% CI 1.541–98.813, P=0.018), PM involvement (HR 14.274, 95% CI 1.785–114.149, P=0.012), and lymphovascular space invasion (HR 8.871, 95% CI 1.104–71.261, P=0.04), were related to DFS. In multivariate analyses, age (HR 0.748, 95% CI 0.587–0.952, P=0.018) and MTV≥23.4mL (HR 49.559, 95% CI 1.257–1953.399, P=0.037) were determined to be independent prognostic factors of DFS. ConclusionPreoperative MTV is an independent prognostic factor for DFS in patients with cervical cancer treated by radical surgery.