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  1. Jang Yoo, MD*,
  2. Joon Young Choi, MD, PhD*,
  3. Seung Hwan Moon, MD*,
  4. Duk Soo Bae, MD, PhD,
  5. Soo Bin Park, MD*,
  6. Yearn Seong Choe, PhD*,
  7. Kyung-Han Lee, MD, PhD* and
  8. Byung-Tae Kim, MD, PhD*
  1. *Departments of Nuclear Medicine and
  2. Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  1. Address correspondence and reprint requests to Joon Young Choi, MD, PhD, Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. E-mail: jynm.choi{at}samsung.com.

Abstract

Objective We compared the prognostic value of volume-based metabolic parameters determined using fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) (18F-FDG PET) (with other prognostic parameters in uterine cervical cancer.

Methods The subjects were 73 female patients who had an initial diagnosis of uterine cervical cancer and who underwent 18F-FDG PET. Various metabolic or volume-based PET parameters including maximum and average standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) were measured in primary cervical tumors. Survival analysis for disease-free survival or progression-free survival was performed with a Kaplan-Meier method using PET parameters and other clinical variables. For determining independent prognostic factors, Cox regression analysis was performed.

Results Recurrence or disease progression occurred in 23 patients (31.5%). In univariate analysis, patient age (cutoff, 57 years, P < 0.05), International Federation of Gynecology and Obstetrics stage (P = 0.07), primary tumor size (cutoff, 6.7 cm; P < 0.05), lymph node status on PET (P < 0.005), treatment method (P < 0.01), metabolic tumor volume (cutoff, 82 cm3; P = 0.001), and TLG (cutoff, 7600; P = 0.005) were significant predictors of recurrence or progression. In multivariate analysis, both lymph node status on PET (hazard ratio, 1.042 [negative vs intrapelvic metastasis only], 7.008 [negative vs extrapelvic metastasis]; P < 0.001) and TLG (cutoff, 7600; hazard ratio, 2.981; P < 0.05) were independent prognostic factors for predicting recurrence.

Conclusions In uterine cervical cancer, TLG, a volume-based metabolic parameter, and lymph node status on PET may be significant independent prognostic factors for event-free survival.

  • Uterine cervical cancer
  • Prognosis
  • 18F-FDG PET
  • Metabolic tumor volume
  • Total lesion glycolysis

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Footnotes

  • This study was supported by grants from the Samsung Medical Center Clinical Research Development Program grant no. CRS-111-17-1, Republic of Korea.

  • The authors declare no conflicts of interest.

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