Prognostic value of total lesion glycolysis measured by ¹⁸F-FDG PET/CT in patients with locally advanced cervical cancer

Aim The aim of this study was to determine the most relevant parameters of fluorine-18 fluorodeoxyglucose (18 F-FDG) PET/computed tomography (CT) for predicting recurrence in patients with locally advanced cervical cancer. Materials and methods Fifty-six patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IVA cervical cancer who underwent 18 F-FDG PET/CT before definitive chemoradiotherapy were retrospectively enrolled. Various PET parameters, namely, maximum standardized uptake value, mean standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor, were analyzed to evaluate the relationship between these PET parameters and recurrence-free survival (RFS). The cut-off values of PET parameters that showed the best trade-off between sensitivity and specificity for RFS were determined by receiver operating characteristic curve analysis. Results The median follow-up was 20 months (range, 6-63 months). Univariate analysis indicated that higher FIGO stage [hazard ratio (HR) 5.606, 95% confidence interval (CI) 1.682-18.68, P=0.005], metabolic tumor volume more than 47.81 cm³ (HR 6.203, 95% CI 1.351-28.481, P=0.019), and TLG more than 215.02 (HR 11.817, 95% CI 1.518-91.963, P=0.018) were associated with RFS. In multivariate analysis, FIGO stage (HR 4.618, 95% CI 1.295-16.463, P=0.018) and TLG more than 215.02 (HR 10.171, 95% CI 1.246-83.044, P=0.030) were independent predictive factors for RFS. Kaplan-Meier curves for RFS indicated that patients with TLG less than or equal to 215.02 showed better RFS (P=0.003). Conclusion Pretreatment TLG proved to be an independent prognostic factor for RFS in patients with locally advanced cervical cancer treated by definitive chemoradiotherapy.