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Pelvic lymph node F‐18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer
Author(s) -
Kidd Elizabeth A.,
Siegel Barry A.,
Dehdashti Farrokh,
Grigsby Perry W.
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24972
Subject(s) - medicine , cervical cancer , standardized uptake value , lymph node , cervix , fluorodeoxyglucose , population , positron emission tomography , nuclear medicine , cancer , radiology , environmental health
BACKGROUND: The objective of the current study was to evaluate the prognostic significance of the maximum standardized uptake value (SUV max ) of F‐18 fluorodeoxyglucose (FDG) as measured by positron emission tomography (PET) in pelvic lymph nodes in patients with cervical cancer. METHODS: The authors studied cervical cancer patients with pelvic lymph node metastasis, as evidenced on FDG‐PET, who were treated between November 2003 and October 2008. The maximum dimension and SUV max for the most FDG‐avid pelvic lymph node (SUV PLN ) and the SUV max of the primary cervical tumor (SUV cervix ) were recorded from the FDG‐PET/computed tomography (CT) scan. The SUV PLN was analyzed for its association with treatment response, pelvic disease recurrence, disease‐specific survival, and overall survival. RESULTS: The population was comprised of 83 women with International Federation of Gynecology and Obstetrics (FIGO) stages IB1 to IIIB cervical cancer. The average SUV PLN was 6.9 (range, 2.1‐33.0), whereas the average SUV cervix was 14.0 (range, 3.2‐38.4). The SUV cervix and SUV PLN were found to be weakly correlated (correlation coefficient [R 2 ] = 0.301). The average size of the pelvic lymph nodes was 2.1 cm (range, 0.6‐7.9 cm), and was also found to be only weakly associated with the SUV PLN (R 2 = 0.225). The SUV PLN was found to be correlated with an increased risk of persistent disease after treatment ( P = .0025), specifically within the pelvic lymph node region ( P = .0003). The SUV PLN was found to be predictive of an increased risk of ever developing pelvic disease recurrence ( P = .0035). Patients with a higher SUV PLN were found to have significantly worse disease‐specific ( P = .0230) and overall survival ( P = .0378) using Kaplan‒Meier evaluation. A Cox proportional hazards model for the risk of pelvic disease recurrence was performed including SUV PLN, patient age, and tumor stage, and found only an increased SUV PLN to be an independent predictor. CONCLUSIONS: SUV PLN is a prognostic biomarker, predicting treatment response, pelvic recurrence risk, and disease‐specific survival in patients with cervical cancer. Cancer 2010. © 2010 American Cancer Society.