Abstract
The aim of this study was to assess the usefulness of pretherapeutic primary tumor metabolic tumor volume (MTV) in the prognosis of radically treated cervical cancer patients. Retrospective, single-centre analysis was performed on a group of 508 cervical cancer patients. All patients underwent a pretreatment [18F]FDG PET/CT study for the assessment of the disease stage. Several PET-derived parameters—namely, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), total lesion glycolysis (TLG) and MTV, as well as the clinical parameters, were analysed in terms of the overall survival (OS), event-free survival (EFS), locoregional control (LRC) and freedom from distant metastases (FFDM). Hyperthermia and brachytherapy were prognostic for EFS, OS, and LRC.FIGO stage > II showed a significant effect on EFS, OS, and FFDM. Moreover, hysterectomy was prognostic for OS and histology was prognostic for FFDM. From the PET-derived parameters only MTV of the primary tumor had a significant influence on OS (cutoff point: >12.7 mL, HR: 2.8, 1.75–4.48 95% CI, p < 0.001), LRC (cutoff point: >13.7 mL, HR 2.82, 1.42–5.61 95% CI, p = 0.003), EFS (cutoff point: >10.4 mL, HR: 2.57, 1.67–3.97 95% CI, p < 0.001) and FFDM (cutoff point: >10.4 mL, HR: 5.04, 1.82–13.99 95% CI, p = 0.002). Pretreatment MTV from the primary tumor is the only independent prognostic parameter in OS, LRC, EFS, and FFDM in radically treated cervical cancer patients and should be used in clinical practice in assessing prognosis in these patients.
Highlights
According to the newest data, cervical cancer ranks fifth in terms of incidence and mortality worldwide (604,127 new cases and 341,831 deaths in 2020) [1]
A total of 402 patients underwent radiochemotherapy (CRT) as primary treatment. Those patients, who were treated with a hysterectomy at the beginning, were stratified to adjuvant treatment according to their risk factors: either chemotherapy or radiotherapy or radiochemotherapy
Univariate Cox regression using the metric PET parameters revealed that only metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are significant prognostic factors for event free survival (EFS), overall survival (OS), and freedom from distant metastases (FFDM)
Summary
According to the newest data, cervical cancer ranks fifth in terms of incidence and mortality worldwide (604,127 new cases and 341,831 deaths in 2020) [1]. Imaging modalities like transvaginal or transrectal ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and lately, positron emission tomography combined with computed tomography (PET/CT) are essential for adequate assessment of tumor size, invasiveness, and detection of distant metastases [3]. MRI and CT are widely used to detect metastatic lymph nodes based on their size and morphological features. Several qualitative and quantitative PET-derived parameters have been found to be prognostic in the pretreatment of cervical carcinoma and in assessing the recurrence and restaging of other gynaecological malignancies [5,6,7,8,9]. Maximum standardised uptake value (SUVmax), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) are the most common PET-derived parameters with proven significance in assessing therapy response and outcome in cervical cancer patients [10,11]
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