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  • Tumor total lesion glycolysis and number of positive pelvic lymph nodes on pretreatment positron emission tomography/computed tomography (PET/CT) predict survival in patients with locally advanced cervical cancer

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Original research
Tumor total lesion glycolysis and number of positive pelvic lymph nodes on pretreatment positron emission tomography/computed tomography (PET/CT) predict survival in patients with locally advanced cervical cancer
  1. Marjolein De Cuypere1,
  2. Pierre Lovinfosse2,
  3. Christine Gennigens3,
  4. Johanne Hermesse4,
  5. Ramon Rovira5,
  6. Joan Duch6,
  7. Frédéric Goffin1,
  8. Roland Hustinx2 and
  9. Frédéric Kridelka1
  1. 1 Obstetrics & Gynecology, University of Liege Central University Hospital N.-D. des Bruyères, Chenee, Belgium
  2. 2 Nuclear Medicine and Oncological Imaging, Central University Hospital of Liege, Liege, Belgium
  3. 3 Medical Oncology, Central University Hospital of Liege, Liege, Belgium
  4. 4 Radiation Oncology, Central University Hospital of Liege, Liege, Belgium
  5. 5 Gynecology Oncology & Laparoscopy, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
  6. 6 Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
  1. Correspondence to Dr Marjolein De Cuypere, Obstetrics & Gynecology, University of Liege Central University Hospital N.-D. des Bruyères, Chenee, Belgium; mdecuypere{at}chuliege.be

Abstract

Objective The aim of this study was to investigate the prognostic value of metabolic parameters obtained at pretreatment [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) in patients with locally advanced cervical cancer. We hypothesize that these metabolic parameters could optimize the treatment decision and thus favor the outcome of patients suffering locally advanced cervical cancer.

Methods Patients with locally advanced cervical cancer underwent pretreatment PET/CT. Standard uptake values (maximum, mean, peak), metabolic tumor volume, and total lesion glycolysis were measured in the tumor and in the hypermetabolic pelvic lymph nodes. The relationship between clinical, pathological, and PET/CT metabolic parameters with recurrence-free survival and overall survival was assessed by Cox regression analysis.

Results 115 patients with a median age of 52 years (range 23–77) presented with locally advanced cervical cancer. After a mean follow-up of 33.0 months after initiation of therapy, 26 patients (22.6%) recurred of which 17 patients had distant metastasis; 18 (15.7%) patients died. Recurrence-free survival at 2 and 5 years was 79.2% and 72.2%, respectively. The total lesion glycolysis of the tumor and the delay between diagnosis and treatment were significantly associated with recurrence-free survival in the multivariate analysis (HR 1.00, p=0.004, and HR 2.04, p=0.02, respectively). Only the total lesion glycolysis of the tumor ≥373.54 (HR 2.49, 95% CI 1.15 to 5.38; p=0.02) remained significant after log rank testing. Overall survival at 2 and 5 years was 91.7% and 68.8%, respectively. The number of PET-positive pelvic lymph nodes was the only independent prognostic factor for overall survival in the multivariate analysis (HR 1.43, 95% CI 1.13 to 1.81; p=0.003).

Conclusion Tumor total lesion glycolysis and the number of positive pelvic lymph nodes on pretreatment PET/CT appear to be independent prognostic factors for recurrence and survival in patients with locally advanced cervical cancer. This may help to select patients who may benefit from therapeutic optimization and closer surveillance.

  • cervical cancer
  • gynecology
  • neoplasm metastasis
  • neoplasm recurrence
  • local

https://doi.org/10.1136/ijgc-2020-001676

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    Footnotes

    • MDC and PL are joint first authors.

    • Contributors PL can be considered at first co-author. Conception/design: MDC, FK. Provision of study material or patients: FG, CG, RR, JDR, FK. Collection ± assembly of data: MDC, RR, JDR. Data analysis and interpretation: MDC, PL, RH, FK. Manuscript writing: MDC, PL, RH, FK. Final approval of manuscript: MDC, FK.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.