Do clinical characteristics and metabolic markers detected on positron emission tomography/computerized tomography associate with persistent disease in patients with in-operable cervical cancer?
Do clinical characteristics and metabolic markers detected on positron emission tomography/computerized tomography associate with persistent disease in patients with in-operable cervical cancer?
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DOI：
10.1007/s12149-013-0745-1
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发表时间：
2013-10-01
影响因子：
2.6
通讯作者：
Vural, Gulin Ucmak
中科院分区：
文献类型：
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作者：
Akkas, Burcu Esen;Demirel, Busra Bedriye;Vural, Gulin Ucmak
本回顾性研究的目的是评估PET/CT体积代谢标志物与临床特征在不能手术宫颈癌患者中的预后意义。58例宫颈癌（IIB-IVB期）行FDG PET/CT预处理评估并纳入本研究。根据国际妇产科学联合会（FIGO）系统对患者进行分期。放化疗后，通过临床检查、涂片检查、骨盆MRI和PET/CT评估患者是否存在持续性疾病（PD）。根据随访结果，分析临床特征（患者年龄、肿瘤组织学、FIGO分期）和PET/CT表现，如有无PET阳性盆腔/主动脉旁淋巴结（LN）、肿瘤代谢体积（MTV）、病灶总糖酵解（TLG）、肿瘤和淋巴结的最大标准化摄取值（SUVmax），以判断疾病的持续性。采用Kaplan-Meier法，结合PET检查结果和临床特征对无病生存期和总生存期进行生存分析。在最后一次随访时（平均：22 +/- 12.6个月，范围6-48），38例（65%）患者患有PD， 20例（35%）患者无疾病证据（NED）。患者年龄、肿瘤组织学、MTV、TLG和肿瘤SUVmax组间无差异。pet阳性盆腔/主动脉旁淋巴结的频率（84比60%，p = 0.03）、LN SUVmax（10.2比6.5,p = 0.02）和FIGO分期在PD组和NED组之间差异显著。Cox比例风险模型显示，晚期FIGO分期和pet阳性的主动脉旁LN是PD的独立预测因素。无病生存和总生存曲线均随疾病进展而逐渐恶化，p = 0.015。PET LN状态是无病生存期和总生存期最重要的预后指标。所有患者中pet阳性的主动脉旁淋巴结患者预后曲线最差，p = 0.03。晚期FIGO分期和预处理PET/CT上存在FDG-avid主动脉旁淋巴结是PD的重要预后生物标志物，并降低了不可手术宫颈癌患者的总生存率，不依赖于MTV， TLG，肿瘤和淋巴结SUVmax。
The objective of this retrospective study was to evaluate the prognostic significance of volume-based metabolic markers of PET/CT along with clinical characteristics in patients with in-operable cervical carcinoma.Fifty-eight patients with cervical carcinoma (stage IIB-IVB) underwent FDG PET/CT for pretreatment evaluation and included in this study. Patients were staged according to International Federation of Gynecology and Obstetrics [FIGO] system. After chemoradiation therapy, patients were evaluated for persistent disease (PD) by clinical examinations, smear tests, pelvic MRI and PET/CT. Based upon follow-up results, clinical characteristics (patient age, tumor histology, FIGO stage) and PET/CT findings such as presence of PET-positive pelvic/para-aortic lymph nodes (LN), metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake values (SUVmax) of tumor and lymph nodes were analyzed for disease persistence. Survival analysis for disease-free survival and overall survival was performed with Kaplan-Meier method using PET findings and clinical characteristics.At the time of last follow-up (mean: 22 +/- A 12.6 months, range 6-48), 38 patients (65 %) had PD, 20 patients (35 %) had no evidence of disease (NED). Patient age, tumor histology, MTV, TLG and tumor SUVmax did not differ between groups. The frequency of PET-positive pelvic/para-aortic lymph nodes (84 vs. 60 %, p = 0.03), LN SUVmax (10.2 vs. 6.5, p = 0.02), and FIGO stage differed significantly between PD and NED groups. Cox proportional hazards model demonstrated advanced FIGO stage and the presence of PET-positive para-aortic LN were independent predictors for PD. Both disease-free survival and overall survival curves showed progressive worsening as the disease advanced, p = 0.015. PET LN status was the most important prognostic indicator for disease-free survival and overall survival. The worst outcome curves were detected for patients with PET-positive para-aortic lymph nodes among all patients, p = 0.03.Advanced FIGO stage and the presence of FDG-avid para-aortic lymph nodes on pretreatment PET/CT are significant prognostic biomarkers for PD and decreased overall survival in patients with in-operable cervical carcinoma independent from MTV, TLG, tumor and lymph node SUVmax.