Evaluation Of 18F-FDG PET/CT Parameters For Reflection Of Aggressiveness And Prediction Of Prognosis In Cervical Cancer

Objective: Cervical cancer represents one of the highest incidences of malignant tumors in women,which seriously threatens the life and health of women through direct spread and lymphatic metastasis.With superior sensitivity and specificity in detecting regional glucose metabolism,fluorine-18-fluorodeoxyglucose(18F-FDG)positron emission tomography(PET)/ computed tomography(CT)has been playing an increasingly important role in the management of cervical cancer,and its quantification approach can help with the detection of lymph node metastasis and distant organ metastasis,treatment evaluation,and prognostic prediction.Multiple metabolic parameters can be obtained from PET/CT images.The aim of this study was to investigate the value of five typical PET/CT parameters(including SUVmax,SUVmean,SUVpeak,MTV and TLG)in the reflecting aggressiveness and predicting prognosis in patients with cervical cancer.Methods: We retrospectively analyzed 85 primary cervical cancer patients who underwent preoperative 18F-FDG PET/CT scans in our hospital from March to December 2013.We investigated the association of five parameters derived from PET/CT with clinicopathological characteristics.Immunohistochemistry was utilized to evaluate the expression of glucose transporter protein-1(GLUT-1),TP53-induced glycolysis and apoptosis regulator(TIGAR),and vascular endothelial growth factor(VEGF),and the correlation between PET/CT parameters and the expression of GLUT-1,TIGAR,and VEGF was analyzed.In addition,we also investigated the correlation between disease-free survival of cervical cancer patients and PET/CT parameters.Results: 1.The mean peak standardized uptake value(SUVpeak)showed significant differences between all three International Federation of Gynecology and Obstetrics stages(P<0.001–0.032).The patients with lymph node metastasis had significantly higher SUVpeak,metabolic tumor volume(MTV),and total lesion glycolysis(TLG)compared with those with the absence of lymph node metastasis(P=0.038,0.024,and0.010,respectively).All the five parameters showed an association with tumor size and cervical stromal invasion depth(P<0.05).2.Immunohistochemistry results indicated that the SUVpeak showed the highest association with the expression of GLUT-1,TIGAR,and VEGF(rs=0.705,P<0.001,rs=-0.466,P<0.001,rs=0.580,P<0.001,respectively)in these five parameters.3.The survival analysis showed that SUVpeak,MTV,and TLG were correlated with disease-free survival(P=0.042,P<0.001,and P=0.004,respectively).Conclusion: Cervical cancer with high SUVpeak may reflect more aggressive behavior,and SUVpeak,MTV,and TLG can be used to predict the prognosis of cervical cancer patients.It may help with the choice of individualized treatment options.