Tumor and metastatic lymph nodes metabolic activity on ¹⁸F-FDG-PET/CT to predict progression-free survival in locally advanced cervical cancer

The present study investigated the predictive diseases progression value of preoperative fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with local advanced cervical cancer (LACC).

In total, 267 patients [median age 58 (range: 27–85) years old] with LACC underwent ¹⁸F-FDG PET/CT prior to any treatment. The maximum standardized uptake values (SUV_max), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesion and metastatic lymph nodes were measured on PET/CT and correlated with clinicopathological features and progression-free survival (PFS).

The median follow-up was 36.52 (range: 3.09–61.29) months. During the observation period, 80 (30.0%) patients exhibited disease progression. Univariate analysis showed that FIGO stage, concurrent chemoradiotherapy (CRT), serum level of carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag), primary tumor MTV (pMTV) and TLG (pTLG), lymph nodes SUV_max (nSUV_max) and TLG (nTLG), and total metabolic activity (sMTV, sTLG) were associated with PFS. nSUV_max ≥ 5.29, CEA ≥ 7.11 ng/ml and deficiency of concurrent CRT were independent risk factor for PFS (p = 0.006, p = 0.008, p = 0.014). The 3-year PFS for patients with high nSUV_max were 42.2% compared to 56.3% for low nSUV_max values.

Pretreatment cervical and lymph nodes metabolic parameters were associated with PFS in patients with LACC.