This is an observational study to determine the most relevant parameter of 1818-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting recurrence in cervical cancer. Fifty-six patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IVA cervical cancer who underwent pretreatment 1818-FDG PET/CT were enrolled. PET parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of both primary tumor and pelvic and/or para-aortic lymph nodes were analyzed. SUVmax-S was defined as the sum of the SUVmax of primary tumor and the higher SUVmax of either pelvic or para-aortic lymph nodes. MTV-S was defined as the sum of the MTV of primary tumor and pelvic and para-aortic lymph nodes. TLG-S was calculated in the same way as MTV-S. We evaluated the relationship between these PET parameters and recurrence-free survival (RFS). Univariate analysis revealed that higher FIGO stage (hazard ratio [HR]=5.61, 95% confidence interval [CI]: 1.68-18.68, P=0.005), lymph node metastasis (HR=3.42, 95% CI: 1.08-10.84, P=0.037), MTV of primary tumor >47.81 cm3 (HR=6.20, 95% CI: 1.35-28.48, P=0.019), TLG of primary tumor >215.02 (HR=11.82, 95% CI: 1.52-91.96, P=0.018), MTV-S >59.01 cm3 (HR=8.24, 95% CI: 1.80-37.77, P=0.007), and TLG-S >224.15 (HR= 13.09, 95% CI: 1.68-101.89, P=0.014) were associated with RFS. In multivariate analysis, FIGO stage (HR=4.87, 95% CI: 1.38-17.18, P=0.014) and MTV-S >59.01 cm3 (HR=7.37, 95% CI: 1.54-35.16, P=0.012) were determined to be independent predictive factors for RFS. Our preliminary results reveal that MTV-S is an independent prognostic factor for RFS in patients with cervical cancer treated by definitive chemoradiotherapy.
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