Prognostic value of metabolic tumor volume measured by FDG-PET/CT in patients with cervical cancer

Objective. To determine if preoperative metabolic tumor volume (MTV) measured by integrated F-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (FDG-PET/CT) imaging has prognostic value in patients with cervical cancer treated primarily with radical hysterectomy. Methods. Patients with FIGO stage IB to IIA cervical cancer were imaged with FDG-PET/CT before radical surgery. MTV was measured from attenuation-corrected FDG-PET/CT images using a standard uptake value (SUV)-based automated contouring program. We evaluated the relationship of MTV to disease-free survival (DFS). Results. A total of 63 patients were included in the study. The cut-off value for predicting recurrence was determined using a receiver operating characteristic (ROC) curve. MTV in this study was found to be correlated with ymph node (LN) metastasis, parametrium (PM) involvement, FIGO stage, and SUVmax. In univariate analysis, MTV >= 23.4 mL (HR 1.017, 95% confidence interval (Cl) 1.005-1.029, P=0.004), SUVmax >= 9.5 (HR 5.198, 95% Cl 1.076-25.118, P=0.04), LN metastasis (HR 12.338, 95% Cl 1.541-98.813, P=0.018), PM involvement (HR 14.274, 95% Cl 1.785-114.149, P=0.012), and lymphovascular space invasion (HR 8.871,95% Cl 1.104-71.261, P=0.04), were related to DFS. In multivariate analyses, age (HR 0.748, 95% Cl 0.587-0.952, P=0.018) and MTV >= 23.4 mL (HR 49.559, 95% Cl 1.257-1953.399, P=0.037) were determined to be independent prognostic factors of DFS. Conclusion. Preoperative MTV is an independent prognostic factor for DFS in patients with cervical cancer treated by radical surgery. (C) 2010 Elsevier Inc. All rights reserved.