Metabolic tumour volume and total lesion glycolysis, measured using preoperative ¹⁸F–FDG PET/CT, predict the recurrence of endometrial cancer

Abstract

Objective To investigate the prognostic value of metabolic tumour volume (MTV) and total lesion glycolysis (TLG), measured by preoperative positron emission tomography and computerised tomography (PET/CT), in women with endometrial cancer.Design Retrospective cohort study. Methods Clinicopathological data for 84 women with endometrial cancer were reviewed from medical records. Cox proportional hazards modelling identified recurrence predictors. The receiver operating characteristic (ROC) curve was used to determine the cut-off value for predicting recurrence.Main outcome measure Disease-free survival (DFS).Results The number of patients with International Federation of Gynecology and Obstetrics (FIGO) stages were: I (58); II (11); III (13); and IV (2). The median DFS was 48 (1-85) months. By univariate analysis, DFS was significantly associated with FIGO stage, histology, peritoneal cytology, myometrial invasion, nodal metastasis, serum CA-125, MTV, and TLG. Using multivariate analysis, the MTV (P = 0.010; hazard ratio, HR = 1.010; 95% confidence interval, 95% CI = 1.002-1.018) and TLG (P = 0.024; HR = 1.001; 95% CI = 1.000-1.002) were associated with DFS. The area under the ROC curve was 0.679 (95% CI = 0.505-0.836) after discriminating for recurrence using an MTV cut-off value of 17.15 ml. Regarding TLG, the cut-off value was 56.43 g and the area under the ROC plot was 0.661 (95% CI = 0.501-0.827). Kaplan-Meier survival graphs demonstrated a significant difference in DFS between groups categorised using the cut-off values for MTV and TLG (P < 0.022 for MTV and P < 0.047 for TLG, by log-rank test).Conclusions Preoperative MTV and TLG could be independent prognostic factors predicting the recurrence of endometrial cancer.

Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

“…The protocol included 6 h of fasting before image acquisition, and all patients were asked to void before undergoing scanning. 18 F-FDG (322-414 MBq) was given intravenously 60-120 min before the CT scan, and the patients rested in a semidark, temperate room between injection and scanning. Low-dose CT (120 kV, 50 mAs) for attenuation correction of the PET data was performed before the static emissions, which were obtained at a rate of 3 min per bed position; immediately thereafter, intravenous contrast agent (Iomerol, 350 mg iodine/mL; Bracco Imaging Scandinavia, AB) and negative oral contrast agent (water) were administered for the subsequent diagnostic CT scan (120 mV, 240 mAs), covering a region from the meatus of the ear to the proximal thigh.…”

“…This form included information on tumor avidity and uptake intensity, as well as metabolic tumor volume (MTV). Information on the presence of increased 18 F-FDG uptake in the cervix (interpreted as cervical stroma invasion), in lymph nodes (interpreted as lymph node metastases), and at distant sites (interpreted as likely metastases) was also recorded. The depth of myometrial invasion based on 18 F-FDG uptake was not recorded, because the low resolution of the PET signal was perceived to preclude such assessment.…”

“…18 F-FDG PET/CT combines morphologic and physiologic techniques and is the preferred imaging method for various cancers (11). Although several studies have suggested that 18 F-FDG PET/CT can be beneficial preoperatively in endometrial cancer patients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), its clinical role in risk stratification of such patients is not well defined. Furthermore, the value of various quantitative tumor parameters and the corresponding optimal cutoffs for the prediction of tumor stage and prognosis are largely unexplored.…”

“…The aim of the present study was to prospectively explore the diagnostic value of preoperative 18 F-FDG PET/CT for staging of endometrial carcinoma and to investigate the extent to which 18 F-FDG PET-specific quantitative tumor parameters reflect clinical and histologic tumor characteristics. To further explore clinical applicability, we assessed interobserver agreement for 18 F-FDG PET/CT staging parameters and quantitative tumor parameters and the prevalence and significance of incidental findings on prospective and consecutive 18 F-FDG PET/CT investigations of a populationbased endometrial carcinoma cohort.…”

“…To further explore clinical applicability, we assessed interobserver agreement for 18 F-FDG PET/CT staging parameters and quantitative tumor parameters and the prevalence and significance of incidental findings on prospective and consecutive 18 F-FDG PET/CT investigations of a populationbased endometrial carcinoma cohort.…”