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. 2022 Jul 23;22(1):810.
doi: 10.1186/s12885-022-09785-w.

Metabolic activity determines survival depending on the level of lymph node involvement in cervical cancer

Alejandra Martinez  1   2 , Elodie Chantalat  3 , Martina Aida Angeles  4 , Gwénaël Ferron  4   5 , Anne Ducassou  6 , Manon Daix  4 , Justine Attal  6 , Sarah Bétrian  7 , Amélie Lusque  8 , Erwan Gabiache  9
Affiliations

Metabolic activity determines survival depending on the level of lymph node involvement in cervical cancer

Alejandra Martinez et al. BMC Cancer. .

Abstract

Background: To assess the impact of PET/CT functional parameters on survival, locoregional, and distant failure according to the most distant level of lymph node [18F]FDG uptake in patients with locally advanced cervical cancer (LACC).

Methods: Retrospective study including 148 patients with LACC treated with concurrent chemoradiotherapy after PET/CT and para-aortic lymph node (PALN) surgical staging. Two senior nuclear medicine physicians reviewed all PET/CT exams and retrieved tumor and lymph node metabolic parameters: SUVmax, MTV, TLG. Oncological outcomes according to metabolic parameters and level of lymph node spread on PET/CT were assessed.

Results: In patients without lymph node uptake on PET/CT, high MTV values of the cervical tumor were associated with DFS (HR = 5.14 95%CI = [2.15-12.31]), OS (HR = 6.10 95%CI = [1.89-19.70]), and time to distant (HR = 4.73 95%CI = [1.55-14.44]) and locoregional recurrence (HR = 5.18 95%CI = [1.72-15.60]). In patients with pelvic lymph node (PLN) uptake but without PALN uptake on [18F]FDG-PET/CT, high MTV values of the cervical tumor were associated with DFS (HR = 3.17 95%CI = [1.02-9.83]) and OS (HR = 3.46 95%CI = [0.96-12.50]), and the number of PLN fixations was associated with DFS (HR = 1.30 95%CI = [1.10-1.53]), OS (HR = 1.35 95%CI = [1.11-1.64]), and time to distant (HR = 1.35 95%CI = [1.08-1.67]) and locoregional recurrence (HR = 1.31 95%CI = [1.08-1.59]). There was no significant association between cervical tumor metabolic or lymph node metrics and survival outcome in patients with PALN uptake.

Conclusions: Cervical MTV is more accurate than SUVmax to predict survival outcome in patients with locoregional disease confined to the pelvis and should be implemented in routine clinical practice. Prognostic value of metabolic metrics disappears with PALN uptake, which is associated with distant failure in nearly half of patients.

Keywords: Fluorodeoxyglucose F18; Locally advanced cervical cancer; Lymphatic metastasis; Positron Emission Tomography Computed Tomography; Survival Analysis; Uterine Cervical Neoplasms.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
a Overall survival (OS) according to lymph node spread; b Disease-free survival (DFS) according to lymph node spread; c OS according to MTV values; d DFS according to MTV values
Fig. 2
Fig. 2
PET images of a patient presenting with a cervical tumor with left pelvic lymph node involvement. a) cervical tumor contouring with semi-automatic tumor thresholding method at 40% of the SUVmax (SUVmax 22.8; TLG 372.9 g/ml*cm3; MTV 37.16 cm3); b) the same procedure with a left pelvic involved lymph node with SUVmax 7.9; TLG 8.7 g/ml*cm3; MTV 1.65 cm3; c) Maximum intensity projection showing the absence of distant metastasis
See this image and copyright information in PMC

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