Prognostic Importance of ¹⁸F-FDG Positron Emission Tomography in Uterine Cervical Cancer

The aim of this study was to evaluate the prognostic value of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) in the uterine cervix cancer patients.

Thirty-two women (mean age: 52.7±12.6) who underwent ¹⁸F-FDG PET/CT for staging of uterine cervix cancer were retrospectively recruited for the study. Maximum standardized uptake value (SUV_max), SUV_mean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors, lymph nodes, and distant metastases were calculated from ¹⁸F-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 ¹⁸F-FDG PET/CT images. Life tables and Kaplan-Meier analyses were performed to compare the mean survival times of the different groups.

Primary tumor of 27 (84%) patients were ¹⁸F-FDG avid. The median SUV_max, SUV_mean, MTV, and TLG of the primary tumors were 12.4, 6.1, 13.2 cm³ and 87.8 g/mL x cm³ 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 cm³ and 91.1 g/mL x cm³. 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_max in the primary tumor (p=0.038). During follow-up period 8 patients died. SUV_max (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.

Metabolic parameters of primary tumors derived from ¹⁸F-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.