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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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 (SUVcervix) and LN (SUVLN), and the LN-to-cervical cancer SUV ratio (SUVLN/SUVcervix) 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 SUVLN / SUVcervix > 0.1747(P = 0.048) was the independent risk factor of recurrence. Patient group categorized by SUVLN/SUVcervix showed significant difference in PFS (log-rank test, P < 0.001).

Conclusions

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

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References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  CAS  PubMed  Google Scholar 

  3. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. 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.

    Article  CAS  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Hyun Hoon Chung, Jae-Weon Kim, Noh-Hyun Park & Yong Sang Song

  2. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    Gi Jeong Cheon

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  1. Hyun Hoon Chung
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Correspondence to Hyun Hoon Chung.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required.

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Chung, H.H., Cheon, G.J., Kim, JW. et al. Prognostic importance of lymph node-to-primary tumor standardized uptake value ratio in invasive squamous cell carcinoma of uterine cervix. Eur J Nucl Med Mol Imaging 44, 1862–1869 (2017). https://doi.org/10.1007/s00259-017-3729-x

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  • DOI: https://doi.org/10.1007/s00259-017-3729-x

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