Prognostic value of lymph node-to-primary tumor standardized uptake value ratio in endometrioid endometrial carcinoma

  • Hyun Hoon ChungEmail author
  • Gi Jeong Cheon
  • Jae-Weon Kim
  • Noh-Hyun Park
  • Yong Sang Song
Original Article



To determine whether the relative metabolic activity of pelvic or para-aortic LN compared with that of primary tumor measured by preoperative [18F]FDG PET/CT scan has prognostic value in patients with endometrioid endometrial carcinoma.


We retrospectively reviewed patients with endometrioid endometrial carcinoma who underwent preoperative [18F]FDG PET/CT scans. Prognostic values of PET/CT-derived metabolic variables such as maximum standardized uptake value (SUV) of the primary endometrial carcinoma (SUVTumor) and LN (SUVLN), and the LN-to-endometrial carcinoma SUV ratio (SUVLN / SUVTumor) were assessed.


Clinico-pathological data, imaging data, and treatment results were reviewed for 107 eligible patients. Median post-surgical follow-up was 23 months (range, 6–60), and 7 (6.5%) patients experienced recurrence. Regression analysis showed that SUVLN / SUVTumor (P < 0.001), SUVLN (P = 0.003), International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.006), and tumor grade (P = 0.011) were risk factors of recurrence. Multivariate regression analysis revealed that FIGO stage (P = 0.034) was the independent risk factor of recurrence. SUVLN / SUVTumor showed significant correlation with FIGO stage (P < 0.001), LN metastasis (P < 0.001), lymphovascular space invasion (P < 0.001), recurrence (P = 0.001), tumor grade (P < 0.001), and deep myometrial invasion of tumor (P = 0.022). Patient groups categorized by SUVLN / SUVTumor showed significant difference in progression-free survival (Log-rank test, P = 0.001).


Preoperative SUVLN / SUVTumor measured by [18F]FDG PET/CT was significantly associated with recurrence, and may become a novel prognostic factor in patients with endometrioid endometrial carcinoma.


[18F]FDG pet/ct Ratio SUV LN Endometrioid endometrial carcinoma 




Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

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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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Nuclear Medicine, Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea

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