Correlation Between Metabolic Parameters Of ¹⁸F FDG PET-CT And The Prognosis Of Cervical Carcinoma Patients Treated With Concurrent Chemoradiotherapy

ObjectiveTo investigate the correlation between the metabolic parameters of ¹⁸F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography(¹⁸F FDG PET-CT)and survival of cervical cancer patients treated with concurrent chemoradiotherapy（CCRT）,and to provide a basis for the prognosis assessment of patients with cervical cancer.MethodsThe retrospective study was performed on 78 patients with cervical cancer diagnosed by biopsy and pathology between December 2011 and December 2018.All patients were treated with CCRT and underwent ¹⁸F FDG PET-CT within 4 weeks prior to treatment.Clinical factors of patients were collected:age of onset,the International Federation of Gynecology and Obstetrics（FIGO）stage,histopathological type,maximum tumor diameter,pelvic lymph node metastasis,para-aortic lymph node metastasis,radiotherapy duration and concurrent chemotherapy course.The metabolic parameters of ¹⁸F FDG PET-CT were measured,which included maximum standardized uptake value(SUV_max),mean standardized uptake value(SUV_mean),peak standardized uptake value(SUV_peak),tumor metabolic volume（MTV）and total lesion glycolysis（TLG）.The receiver operating characteristic（ROC）curves were plotted,and the cut-off values of SUV_max,SUV_mean,SUV_peak,MTV and TLG for predicting the death and recurrence of cervical cancer were obtained by Youden index.Kaplan-Meier analysis was used to draw the overall survival（OS）and disease-free survival（DFS）curves of each factor.Log-rank method was used to conduct univariate survival analysis.Factors that had significant influence on OS and DFS were included into Cox regression model for multivariate survival analysis.ResultsA total of 78 patients with cervical cancer were included in this study,and the median follow-up was 31.6 months（6-101 months）.Twenty patients relapsed and 13 died during follow-up.ROC curves were drawn with death as the end point event,and the AUC of SUV_max,SUV_mean,SUV_peak,MTV and TLG were 0.693,0.643,0.691,0.689 and 0.807respectively.According to Youden index,the cut-off values were 17.81,8.81,12.56,47.70and 414.50 respectively.ROC curves were drawn with recurrence as the end point.The AUC of these metabolic parameters were 0.606,0.601,0.600,0.771 and 0.814,and the cut-off values were 18.28,11.06,12.49,47.70 and 334.23,respectively.Univariate survival analysis showed that FIGO stageⅢ-Ⅳ,para-aortic lymph node metastasis,concurrent chemotherapy course<4 times,SUV_max≥17.81,SUV_peak≥12.56,MTV≥47.70 and TLG≥414.50 were prognostic risk factors of OS.Pelvic lymph node metastasis,para-aortic lymph node metastasis,SUV_max≥18.28,MTV≥47.70,TLG≥334.23 were adverse prognostic factors of DFS.Multivariate survival analysis showed that para-aortic lymph node metastasis,concurrent chemotherapy<4 times,SUV_peak≥12.56,MTV≥47.70 and TLG≥414.50 were independent influencing factors of OS.Para-aortic lymph node metastasis and TLG≥334.23 were independent influencing factors of DFS.ConclusionsPara-aortic lymph node metastasis is a common adverse prognostic factor for both OS and DFS in cervical cancer patients treated with CCRT.Patients with higher TLG value may have a greater risk of distant metastasis and death.The metabolic parameters of ¹⁸F FDG PET-CT of primary lesion before treatment have certain value for prognosis evaluation and survival improvement of CCRT cervical cancer patients.