Prognostic importance of lymph node-to-primary tumor standardized uptake value ratio in invasive squamous cell carcinoma of uterine cervix

Abstract

Purpose: Using integrated PET/CT, we evaluated the prognostic value of [¹⁸F]FDG uptake ratio between pelvic lymph node (LN) and primary tumor in invasive squamous cell carcinoma (SCCA) of the uterine cervix.

Methods: We retrospectively reviewed patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB to IIA cervical SCCA who underwent preoperative [¹⁸F]FDG PET/CT scans. PET/CT parameters such as maximum standardized uptake value (SUV) of the primary cervical cancer (SUV_cervix) and LN (SUV_LN), and the LN-to-cervical cancer SUV ratio (SUV_LN/SUV_cervix) were assessed. Prognostic values of PET/CT-derived metabolic and volumetric variables and clinicopathology parameters were analyzed to predict progression-free survival (PFS) in regression analyses.

Results: Clinical data, treatment modalities, and results were reviewed for 103 eligible patients. Median post-surgical follow-up was 29 months (range, 6-89), and 19 (18.5%) patients experienced recurrence. Multivariate logistic regression analysis showed that SUV_LN / SUV_cervix > 0.1747(P = 0.048) was the independent risk factor of recurrence. Patient group categorized by SUV_LN/SUV_cervix showed significant difference in PFS (log-rank test, P < 0.001).

Conclusions: Preoperative SUV_LN/SUV_cervix measured by [¹⁸F]FDG PET/CT was significantly associated with recurrence, and has an incremental prognostic value for PFS in patients with cervical SCCA.

Keywords: Cervical cancer; Ln; Ratio; SCCA; [18F]FDG pet/Ct.