Prognostic impact of primary tumor SUVmax on preoperative 18F-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography in endometrial cancer and uterine carcinosarcoma

Abstract

Abstract. The objective of the present study was to investigate the usefulness of the maximum standardized uptake value (SUV max ) of the primary tumor on preoperative 18 F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) as a prognostic indicator in patients with endometrial neoplasms. A total of 75 patients with endometrial cancer or uterine carcinosarcoma who underwent surgical treatment were included in the present study. All patients underwent preoperative PET/CT, and the correlation between the SUV max of the primary tumor and clinical outcomes was analyzed. The SUV max was significantly higher in patients with stage II/ III disease, a histology of grade 3 endometrioid adenocarcinoma and carcinosarcoma, a positive lymph node (LN) status, positive lymph-vascular space involvement (LVSI), and deep (≥1/2) myometrial invasion. Receiver operating characteristic curve analysis revealed that the optimal cut-off values of SUV max for predicting a positive LN, LVSI and deep myometrial invasion were 7.49, 6.45 and 6.45, respectively. The overall survival (OS) and progression-free survival (PFS) of patients with a high SUV max were significantly lower compared with those of patients with a low SUV max using the cut-off value of 7.30. However, no significant difference was observed in the OS or PFS between the high and low SUV max groups when analyzed in carcinosarcoma patients alone. Finally, multivariate analyses demonstrated that the SUV max of the primary tumor was an independent prognostic factor for impaired PFS in 55 endometrioid adenocarcinoma patients; however, not in all patients, including those with carcinosarcoma. The present findings demonstrated that the SUV max of the primary tumor may be a useful biomarker for predicting clinical outcomes of patients with endometrial cancer, although its prognostic impact appears to be limited in patients with uterine carcinosarcoma.

Diagnostic Accuracy of Preoperative Metabolic ¹⁸F-FDG PET/CT Parameters for Patients with Endometrial Cancer Treated with Postoperative Radiation Therapy

“…However, few studies have examined the diagnostic accuracy of PET/ CT for the detection of LNM in EC, and available results show variable accuracy (11). Studies have reported that 18 F-FDG PET/CT have high specificity in detecting metastatic nodes; however, its sensitivity was only modest and affected by the size of the metastatic deposit (12,13). In our study, we found high sensitivity, specificity, and accuracy of SUV max -P with a specific cut-off value in the detection of LNM, and this finding was diffferent from those of previous studies.…”

“…Previous studies have demonstrated that high SUV max -T can be associated with the aggres siveness of EC (3,4), although its effect on overall survival or locoregional relapse remains controversial (5,11). Yahata et al (13) reported that a high SUV max -T was predictive of risk factors, such as deep MI, locally advanced stage, and node metastasis in EC. In contrast to these studies, the present study showed that SUV max -T had significant relation only with tumor diameter in patients with EC.…”

True hypopharyngeal carcinosarcoma: a case report and literature review

“…[13][14][15]31,33 F-FDG PET/CT scans performed in 12 previous studies (Table 3). The various anatomical sites were the uterus (six studies, median SUVmax: 10.13), 25,[46][47][48][49][50] prostate (one study, SUVmax: 9.70), 23 liver (one study, SUVmax: 17.10), 24 stomach (one study, SUVmax: 11.90), 51 pulmonary system (two studies, median SUVmax: 10.47), 52,53 and hypopharynx (one study, SUVmax: 8.06). 15 Furthermore, the median SUVmax of all of these studies was 11.23, similar to the value of 10.30 reported in our study.…”

Diagnostic imaging using positron emission tomography for gynecological malignancy

“…In a metaanalysis and other recent studies, higher preoperative SUVmax was an independent prognostic factor for PFS and OS in endometrial cancer. [57][58][59] In contrast, in carcinosarcoma (CS) defined as a subtype of epithelial endometrial carcinoma in the 2009 revision of FIGO, 1 preoperative TLG, but not SUVmax, was an independent risk factor for PFS. 58,60 Patients with CS had significantly worse OS compared with endometrioid endometrial carcinoma, even for early-stage disease.…”

“…[57][58][59] In contrast, in carcinosarcoma (CS) defined as a subtype of epithelial endometrial carcinoma in the 2009 revision of FIGO, 1 preoperative TLG, but not SUVmax, was an independent risk factor for PFS. 58,60 Patients with CS had significantly worse OS compared with endometrioid endometrial carcinoma, even for early-stage disease. The aggressiveness of CS may thus contribute to the different prognostic biomarkers compared with endometrioid endometrial carcinoma.…”