The standardized uptake value for F‐18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival

Abstract

BACKGROUND.: The objective of this study was to evaluate cervical tumor uptake of F‐18 fluorodeoxyglucose (FDG) measured as the maximal standardized uptake value (SUV max) by positron emission tomography (PET) and its association with treatment response and prognosis in patients with cervical cancer. METHODS.: The study population consisted of 287 patients with stage IA2 through IVB cervical cancer who underwent pretreatment FDG‐PET studies. SUV max, tumor volume, and sites of lymph node metastasis were recorded. Therapy included surgery, chemoradiation, or palliation. RESULTS.: The mean SUV max was 11.4 (range, 1–50.4). The mean tumor volume by stage was 42.1 cm 3 for stage I tumors (using International Federation of Gynecology and Obstetrics [FIGO] staging criteria), 63.7 cm 3 for stage II tumors, 129.2 cm 3 for stage III tumors, and 166.2 cm 3 for stage IV tumors. There was no correlation between tumor volume and SUV max (correlation coefficient [R 2] = 0.01). No significant difference in SUV max was observed between squamous histology (n = 247 patients) and nonsquamous histology (n = 40 patients; P = .089). Higher SUV max was associated with an increased risk of lymph node metastasis at diagnosis (P = .0009). A Cox proportional‐hazards model for death from cervical cancer was used to evaluate tumor histology, lymph node metastasis, tumor volume, and SUV max. The results indicated that SUV max was the only significant independent factor (P = .0027). Three prognostic groups were established using SUV max. The overall survival rates at 5 years were 95% for an SUV max ≤ 5.2, 70% for an SUV max > 5.2 and ≤13.3, and 44% for an SUV max > 13.3 (P < .0001). Increasing SUV max was associated with persistent abnormal FDG uptake in the cervix on 3‐month FDG‐PET studies in 238 patients who received curative chemoradiation (P = .04). CONCLUSIONS.: The SUV max of the cervical tumor at diagnosis was a sensitive biomarker of treatment response and prognosis for patients with cervical cancer. Cancer 2007. © 2007 American Cancer Society.