Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography SUV_max in Patients With Locally Advanced Cervical Cancer

Objective: The aim of this study was to investigate the impact of SUV_max fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) measured in the primary tumor, pelvic and para-aortic node with disease-free survival (DFS) and overall survival (OS) in patients with locally advanced cervical cancer. Methods and Materials: A total of 92 patients with histological diagnosis of locally advanced cervical cancer are treated with radiochemotherapy plus brachytherapy boost from January 2008 to April 2014 in our Institution. A pretreatment FDG-PET/CT for staging and radiotherapy planning was performed, and the value of SUV_max measured in primary tumor and positive nodes was related to DFS and OS. Results: Univariate analysis showed that DFS is related to FDG-PET/CT positive para-aortic nodes (P = 0.01), International Federation of Gynecology and Obstetrics (FIGO) stage of disease (P = 0.01), and primary tumor SUV_max (P = 0.02), and OS is related to positive para-aortic nodes (P = 0.01) and primary tumor SUV_max (P = 0.02). In multivariate analysis, DFS is modified by FDG-PET/CT positive para-aortic lymph nodes, stage and high T SUV_max (P = 0.02; P = 0.003; P = 0.04), but the only worse prognostic factor of OS is the high SUV_max in the primary tumor (P = 0.01). Conclusions: We found that T SUV_max, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUV_max correlated with OS.