Preoperative PET/CT standardized FDG uptake values of pelvic lymph nodes as a significant prognostic factor in patients with endometrial cancer

Purpose

Using integrated PET/CT, we evaluated the prognostic relevance of preoperative pelvic lymph node (LN) ¹⁸F-FDG uptake in endometrioid endometrial cancer.

Methods

We retrospectively reviewed patients with pathologically proven endometrial cancer who underwent preoperative ¹⁸F-FDG PET/CT scans to evaluate the prognostic significance of PET/CT parameters and other clinicopathological variables. We used Cox proportional hazards regression to examine the relationship between recurrence and the maximum standardized uptake value (SUV_max) in pelvic LNs (SUV_LN) on FDG PET/CT.

Results

Clinical data, treatment modalities and results were reviewed in 70 eligible patients. The median postsurgical follow-up was 29 months (range 6 to 95 months). Receiver-operating characteristic analysis identified the significant SUV_LN cut-off value as 15. The SUV_LN correlated with FIGO stage (P?<?0.001), LN metastasis (P?<?0.001), lymphovascular space invasion (P?<?0.001), SUV_tumour (P?=?0.001), metastatic LN size (P?=?0.004), primary tumour size (P?=?0.012), tumour grade (P?=?0.015) and depth of tumour invasion (P?=?0.035). Regression analysis showed a statistically significant association between recurrence and SUV_LN (P?=?0.002). Recurrence differed significantly (P?<?0.001) between patients with SUV_LN >15 and those with SUV_LN ≤15.

Conclusion

Preoperative pelvic LN FDG uptake exhibited a strong significant association with recurrence of endometrioid endometrial cancer.