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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-10-2017 | Original Article

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

Authors: Hyun Hoon Chung, Gi Jeong Cheon, Jae-Weon Kim, Noh-Hyun Park, Yong Sang Song

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2017

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.

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108. doi:10.3322/caac.21262.CrossRefPubMed

Monk BJ, Tewari KS, Koh WJ. Multimodality therapy for locally advanced cervical carcinoma: state of the art and future directions. J Clin Oncol. 2007;25(20):2952–65. doi:10.1200/JCO.2007.10.8324.CrossRefPubMed

Monk BJ, Sill MW, McMeekin DS, Cohn DE, Ramondetta LM, Boardman CH, et al. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a gynecologic oncology group study. J Clin Oncol. 2009;27(28):4649–55. doi:10.1200/JCO.2009.21.8909.CrossRefPubMedPubMedCentral

Moore DH, Tian C, Monk BJ, Long HJ, Omura GA, Bloss JD. Prognostic factors for response to cisplatin-based chemotherapy in advanced cervical carcinoma: a gynecologic oncology group study. Gynecol Oncol. 2010;116(1):44–9. doi:10.1016/j.ygyno.2009.09.006.CrossRefPubMed

Moore DH, Blessing JA, McQuellon RP, Thaler HT, Cella D, Benda J, et al. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2004;22(15):3113–9. doi:10.1200/JCO.2004.04.170.CrossRefPubMed

Long HJ 3rd, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, et al. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a gynecologic oncology group study. J Clin Oncol. 2005;23(21):4626–33. doi:10.1200/JCO.2005.10.021.CrossRefPubMed

Oncology FCoG. FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2014;125(2):97–8. doi:10.1016/j.ijgo.2014.02.003.CrossRef

Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997;350(9077):535–40. doi:10.1016/S0140-6736(97)02250-2.CrossRefPubMed

Chung CK, Nahhas WA, Stryker JA, Curry SL, Abt AB, Mortel R. Analysis of factors contributing to treatment failures in stages IB and IIA carcinoma of the cervix. Am J Obstet Gynecol. 1980;138(5):550–6.CrossRefPubMed

10.

Boyce J, Fruchter RG, Nicastri AD, Ambiavagar PC, Reinis MS, Nelson JH Jr. Prognostic factors in stage I carcinoma of the cervix. Gynecol Oncol. 1981;12(2 Pt 1):154–65.CrossRefPubMed

11.

Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a gynecologic oncology group study. Gynecol Oncol. 1990;38(3):352–7.CrossRefPubMed

12.

Werner-Wasik M, Schmid CH, Bornstein L, Ball HG, Smith DM, Madoc-Jones H. Prognostic factors for local and distant recurrence in stage I and II cervical carcinoma. Int J Radiat Oncol Biol Phys. 1995;32(5):1309–17. doi:10.1016/0360-3016(94)00613-P.CrossRefPubMed

13.

Horn LC, Fischer U, Raptis G, Bilek K, Hentschel B. Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer. Gynecol Oncol. 2007;107(2):310–5. doi:10.1016/j.ygyno.2007.06.026.CrossRefPubMed

14.

Waggoner SE. Cervical cancer. Lancet. 2003;361(9376):2217–25. doi:10.1016/S0140-6736(03)13778-6.CrossRefPubMed

15.

Signorelli M, Guerra L, Montanelli L, Crivellaro C, Buda A, Dell’Anna T, et al. Preoperative staging of cervical cancer: is 18-FDG-PET/CT really effective in patients with early stage disease? Gynecol Oncol. 2011;123(2):236–40. doi:10.1016/j.ygyno.2011.07.096.CrossRefPubMed

16.

Bentivegna E, Uzan C, Gouy S, Leboulleux S, Duvillard P, Lumbroso J, et al. Correlation between [18f]fluorodeoxyglucose positron-emission tomography scan and histology of pelvic nodes in early-stage cervical cancer. Anticancer Res. 2010;30(3):1029–32.PubMed

17.

Choi HJ, Ju W, Myung SK, Kim Y. Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: meta-analysis. Cancer Sci. 2010;101(6):1471–9. doi:10.1111/j.1349-7006.2010.01532.x.CrossRefPubMed

18.

Chung HH, Cheon GJ, Kang KW, Kim JW, Park NH, Song YS. Preoperative PET/CT FDG standardized uptake value of pelvic lymph nodes as a significant prognostic factor in patients with uterine cervical cancer. Eur J Nucl Med Mol Imaging. 2014;41(4):674–81. doi:10.1007/s00259-013-2626-1.CrossRefPubMed

19.

Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2009;105(2):103–4.CrossRef

20.

Budiawan H, Cheon GJ, Im HJ, Lee SJ, Paeng JC, Kang KW, et al. Heterogeneity analysis of (18)F-FDG uptake in differentiating between metastatic and inflammatory lymph nodes in adenocarcinoma of the lung: comparison with other parameters and its application in a clinical setting. Nucl Med Mol Imaging. 2013;47(4):232–41. doi:10.1007/s13139-013-0216-6.CrossRefPubMedPubMedCentral

21.

Bradburn MJ, Clark TG, Love SB, Altman DG. Survival analysis part II: multivariate data analysis--an introduction to concepts and methods. Br J Cancer. 2003;89(3):431–6. doi:10.1038/sj.bjc.6601119.CrossRefPubMedPubMedCentral

22.

Bland JM, Altman DG. The logrank test. BMJ. 2004;328(7447):1073. doi:10.1136/bmj.328.7447.1073.CrossRefPubMedPubMedCentral

23.

Altman DG, Gore SM, Gardner MJ, Pocock SJ. Statistical guidelines for contributors to medical journals. Br Med J. 1983;286(6376):1489–93.CrossRef

24.

Nikolic D, Muresan RC, Feng W, Singer W. Scaled correlation analysis: a better way to compute a cross-correlogram. Eur J Neurosci. 2012;35(5):742–62. doi:10.1111/j.1460-9568.2011.07987.x.CrossRefPubMed

25.

Grigsby PW, Siegel BA, Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol. 2001;19(17):3745–9. doi:10.1200/jco.2001.19.17.3745.CrossRefPubMed

26.

Yen TC, See LC, Lai CH, Tsai CS, Chao A, Hsueh S, et al. Standardized uptake value in para-aortic lymph nodes is a significant prognostic factor in patients with primary advanced squamous cervical cancer. Eur J Nucl Med Mol Imaging. 2008;35(3):493–501. doi:10.1007/s00259-007-0612-1.CrossRefPubMed

27.

Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. Pelvic lymph node F-18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer. Cancer. 2010;116(6):1469–75. doi:10.1002/cncr.24972.CrossRefPubMed

28.

Vergote I, Tsolakidis D, Mortier D, Neven P, Amant F, Mottaghy F, et al. Value of positron emission tomography of the para-aortic lymph nodes in cervical carcinoma stage IB2-IIIB. J Clin Oncol. 2008;26(34):5654–5655; author reply 5-7. doi:10.1200/JCO.2008.19.5883.CrossRefPubMed

29.

Yildirim Y, Sehirali S, Avci ME, Yilmaz C, Ertopcu K, Tinar S, et al. Integrated PET/CT for the evaluation of para-aortic nodal metastasis in locally advanced cervical cancer patients with negative conventional CT findings. Gynecol Oncol. 2008;108(1):154–9. doi:10.1016/j.ygyno.2007.09.011.CrossRefPubMed

Title: Prognostic importance of lymph node-to-primary tumor standardized uptake value ratio in invasive squamous cell carcinoma of uterine cervix
Authors: Hyun Hoon Chung
Gi Jeong Cheon
Jae-Weon Kim
Noh-Hyun Park
Yong Sang Song
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2017
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-017-3729-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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