Clinical Research Papers:

Prognostic value of intratumoral metabolic heterogeneity on F-18 fluorodeoxyglucose positron emission tomography/computed tomography in locally advanced cervical cancer patients treated with concurrent chemoradiotherapy

Gun Oh Chong, Won Kee Lee, Shin Young Jeong _, Shin-Hyung Park, Yoon Hee Lee, Sang-Woo Lee, Dae Gy Hong, Jae-Chul Kim and Yoon Soon Lee

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Oncotarget. 2017; 8:90402-90412. https://doi.org/10.18632/oncotarget.18769

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Gun Oh Chong1,*, Won Kee Lee2,*, Shin Young Jeong3, Shin-Hyung Park4, Yoon Hee Lee1, Sang-Woo Lee3, Dae Gy Hong1, Jae-Chul Kim4 and Yoon Soon Lee1

1Department of Obstetrics and Gynecology, Kyungpook National University Medical Center, School of Medicine, Daegu, Republic of Korea

2Medical Research Collaboration Center in KNUH, Kyungpook National University, School of Medicine, Daegu, Republic of Korea

3Department of Nuclear Medicine, Kyungpook National University Medical Center, School of Medicine, Daegu, Republic of Korea

4Department of Radiation Oncology, Kyungpook National University Medical Center, School of Medicine, Daegu, Republic of Korea

*These authors contributed equally to this work as co-first authors

Correspondence to:

Shin Young Jeong, email: [email protected]

Keywords: intratumoral metabolic heterogeneity, locally advanced cervical cancer, 18F-FDG PET/CT, concurrent chemoradiotherapy, prognosis

Received: April 19, 2017     Accepted: June 11, 2017     Published: June 28, 2017


Objective: To evaluate the prognostic value for predicting tumor recurrence of intratumoral metabolic heterogeneity and traditional quantitative metabolic parameters on pre-treatment F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy (CCRT).

Materials and Methods: Ninety-three patients with biopsy-proven cervical cancer and treated with CCRT (FIGO stage IIB-IV) were enrolled in this study. The traditional metabolic parameters of the primary tumor, regional lymph node, and whole body (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis), and intratumoral heterogeneity factor (HF) were measured on pre-treatment 18F-FDG PET/CT images. Univariate and multivariate analyses for disease-free survival (DFS) were performed using clinical and metabolic parameters. The additional HF prognostic value was evaluated by means of time-dependent receiver operating characteristic curve, integrated discrimination improvement, and net reclassification improvement.

Results: On multivariate analysis, nodal SUVmax (hazard ratio 3.60; 95% CI, 1.66–7.85; p = 0.0012) and whole body MTV (WBMTV; hazard ratio 3.15; 95% CI, 1.17–8.53; p = 0.0236) were significant prognostic factors for DFS. When HF was combined with nodal SUVmax and WBMTV, a significant improvement in discrimination for recurrence was observed compared with nodal SUVmax alone (area under curve 0.817 vs. 0.732; p = 0.0028).

Conclusions: HF did not show superiority over traditional metabolic parameters. However, when HF was combined with nodal SUVmax and WBMTV, the predictive value for tumor recurrence improved. Therefore, HF may be a useful additional prognostic biomarker to improve the prognostic value of traditional metabolic parameters on 18F-FDG PET/CT.

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