Textural features of cervical cancers on FDG-PET/CT associate with survival and local relapse in patients treated with definitive chemoradiotherapy

Abstract

We retrospectively reviewed the records of 142 patients with stage IB-IIIB cervical cancer who underwent ¹⁸F-FDG-PET/CT before external beam radiotherapy plus intracavitary brachytherapy and concurrent chemotherapy. The patients were divided into training and validation cohorts to confirm the reliability of predictors for recurrence. Kaplan-Meier analysis was performed and a Cox regression model was used to examine the effects of variables on overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and pelvic relapse-free survival (PRFS). High gray-level run emphasis (HGRE) derived from gray-level run-length matrix most accurately and consistently predicted the presence of pelvic residual or recurrent tumors for both cohorts. In multivariate analysis, stages IIIA-IIIB (P = 0.001, hazard ratio [HR] = 4.07) and a low HGRE (P < 0.0001, HR = 4.34) were prognostic factors for low OS, whereas a low HGRE (P = 0.001, HR = 2.86) and nonsquamous cell histology (P = 0.003, HR = 2.76) were prognostic factors for inferior PFS. The nonsquamous cell histology (P < 0.0001, HR = 9.19) and a low HGRE (P = 0.001, HR = 4.69) were predictors for low PRFS. In cervical cancer patients receiving definitive chemoradiotherapy, pretreatment textural features on ¹⁸F-FDG-PET/CT can supplement the prognostic information.

Figure 1

Overall survival in patients with stage IB–IIB and IIIA–IIIB cervical cancer (1A), and a high HGRE value (>3.68) and a low HGRE value (≤3.68) (1B) (P = 0.005 and P = 0.003, respectively).

Figure 2

Progression-free survival in patients who had tumors with squamous cell carcinoma and nonsquamous cell histology (2A), and those who had an HGRE value > 3.68 and ≤3.68 (2B) (P = 0.003, and P < 0.0001, respectively).

Figure 3

Pelvic relapse-free survival in patients who had tumors with the squamous cell carcinoma and nonsquamous cell histology (3A), and those with an HGRE value >3.68 and ≤3.68 (3B) (P < 0.0001, and P < 0.0001, respectively).