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

Objective 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). Methods In total, 267 patients [median age 58 (range: 27-85) years old] with LACC underwent F-18-FDG PET/CT prior to any treatment. The maximum standardized uptake values (SUVmax), 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). Results 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 SUVmax (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. Conclusion Pretreatment cervical and lymph nodes metabolic parameters were associated with PFS in patients with LACC.