Prognostic Value of Textural Features Obtained from F-fluorodeoxyglucose (F-18 FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in Patients with Locally Advanced Cervical Cancer Undergoing Concurrent Chemoradiotherapy

Abstract

Background To evaluate whether textural features obtained from F-18 FDG PET/CT offer clinical value that can predict the outcome of patients with locally advanced cervical cancer (LACC) receiving concurrent chemoradiotherapy (CCRT). Methods We reviewed the records of 68 patients with stage IIB–IVA LACC who underwent PET/CT before CCRT. Conventional metabolic parameters, shape indices, and textural features of the primary tumor were measured on PET/CT. A Cox regression model was used to examine the effects of variables on overall survival (OS) and progression-free survival (PFS). Results PET/CT parameters were grouped into tertiles (low, middle, and high). In the high group, metabolic tumor volume [hazard ratio (HR), 18.94; 95% confidence interval (CI), 2.27–145.01], shape volume (HR, 21.77; 95% CI, 2.85–166.17), shape compacity (HR, 10.53; 95% CI, 2.38–46.54), gray-level non-uniformity (GLNU) from grey-level run length matrix (GLRLM) (HR, 23.80; 95% CI, 3.13–181.31), and run-length non-uniformity from GLRLM (HR, 10.07; 95% CI, 2.28–44.48) were significant factors for poorer PFS. High coarseness from neighborhood grey-level different matrix (NGLDM) was associated with reduction of recurrence (HR, 0.09; 95% CI, 0.02–0.42). Conclusion Our results demonstrated that several features including textural indices on pretreatment PET/CT were strong prognostic factors for recurrence in patients with LACC receiving CCRT.