Pelvic lymph node F-18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer

Abstract

Background: The objective of the current study was to evaluate the prognostic significance of the maximum standardized uptake value (SUV(max)) of F-18 fluorodeoxyglucose (FDG) as measured by positron emission tomography (PET) in pelvic lymph nodes in patients with cervical cancer.

Methods: The authors studied cervical cancer patients with pelvic lymph node metastasis, as evidenced on FDG-PET, who were treated between November 2003 and October 2008. The maximum dimension and SUV(max) for the most FDG-avid pelvic lymph node (SUV(PLN)) and the SUV(max) of the primary cervical tumor (SUV(cervix)) were recorded from the FDG-PET/computed tomography (CT) scan. The SUV(PLN) was analyzed for its association with treatment response, pelvic disease recurrence, disease-specific survival, and overall survival.

Results: The population was comprised of 83 women with International Federation of Gynecology and Obstetrics (FIGO) stages IB1 to IIIB cervical cancer. The average SUV(PLN) was 6.9 (range, 2.1-33.0), whereas the average SUV(cervix) was 14.0 (range, 3.2-38.4). The SUV(cervix) and SUV(PLN) were found to be weakly correlated (correlation coefficient [R(2)] = 0.301). The average size of the pelvic lymph nodes was 2.1 cm (range, 0.6-7.9 cm), and was also found to be only weakly associated with the SUV(PLN) (R(2) = 0.225). The SUV(PLN) was found to be correlated with an increased risk of persistent disease after treatment (P = .0025), specifically within the pelvic lymph node region (P = .0003). The SUV(PLN) was found to be predictive of an increased risk of ever developing pelvic disease recurrence (P = .0035). Patients with a higher SUV(PLN) were found to have significantly worse disease-specific (P = .0230) and overall survival (P = .0378) using Kaplan-Meier evaluation. A Cox proportional hazards model for the risk of pelvic disease recurrence was performed including SUV(PLN,) patient age, and tumor stage, and found only an increased SUV(PLN) to be an independent predictor.

Conclusions: SUV(PLN) is a prognostic biomarker, predicting treatment response, pelvic recurrence risk, and disease-specific survival in patients with cervical cancer.