PET Parameters are Useful in Predicting Endometrial Cancer Risk Classes and Prognosis

Abstract

Aim We investigate the role of preoperative PET parameters to determine risk classes and prognosis of endometrial cancer (EC).

Methods We enrolled 81 patients with EC who underwent preoperative F-18 FDG PET/CT. PET parameters (SUV_max, SUV_mean, MTV, TLG), grade, histology and size of the primary tumor, stage of the disease, the degree of myometrial invasion (MI), and the presence of lymphovascular invasion (LVI), cervical invasion (CI), distant metastasis (DM) and lymph node metastasis (LNM) were recorded. The relationship between PET parameters, clinicopathological risk factors and overall survival (OS) was evaluated.

Results The present study included 81 patients with EC (mean age 60). Of the total sample, 21 patients were considered low risk (endometrioid histology, stage 1A, grade 1 or 2, tumor diameter < 4 cm, and LVI negative) and 60 were deemed high risk. All of the PET parameters were higher in the presence of a high-risk state, greater tumor size, deep MI, LVI and stage 1B-4B. MTV and TLG values were higher in the patients with non-endometrioid histology, CI, grade 3 and LNM. The optimum cut-off levels for differentiating between the high and low risk patients were: 11.1 for SUV_max (AUC = 0.757), 6 for SUV_mean (AUC = 0.750), 6.6 for MTV(AUC = 0.838) and 56.2 for TLG(AUC = 0.835). MTV and TLG values were found as independent prognostic factors for OS, whereas SUV_max and SUV_mean values were not predictive.

Conclusions The PET parameters are useful in noninvasively differentiating between risk groups of EC. Furthermore, volumetric PET parameters can be predictive for OS of EC.

Zusammenfassung

Ziel Wir untersuchen die Rolle präoperativer PET-Parameter bei der Bestimmung der Risikogruppen und der Prognose von Endometriumkarzinomen (EK).

Methoden Wir haben 81 Patienten mit EC eingeschlossen, bei denen eine präoperative F-18-FDG-PET/CT durchgeführt wurde. PET-Parameter (SUV_max, SUV_mean, MTV, TLG), Graduierung, Histologie und Größe des Primärtumors, das Erkrankungsstadium, der Grad der Myometriuminvasion (MI) und das Vorhandensein einer lymphovaskulären Invasion (LVI), einer Zervixinvasion (CI), einer Fernmetastase und einer Lymphknotenmetastase (LKM) wurden erfasst. Die Relation zwischen PET-Parametern, klinisch-pathologischen Risikofaktoren und dem Gesamtüberleben („overall survival“, OS) wurde bewertet.

Ergebnisse Die vorliegende Studie umfasste 81 Patienten mit EK (Durchschnittsalter 60). Von der Gesamtstichprobe wurden 21 Patienten als Niedrigrisiko-Gruppe (endometrioide Histologie, Stadium 1A, Grad 1 oder 2, Tumordurchmesser < 4 cm und LVI negativ) und 60 als Hochrisikogruppe eingestuft. Alle PET-Parameter waren bei Vorliegen eines Hochrisikos, größerer Tumorgröße, tieferer MI, LVI und einem Stadium 1B–4B höher. MTV- und TLG-Werte waren bei den Patientinnen mit nichtendometrioider Histologie, CI, Grad 3 und LKM höher. Die optimalen Cut-off-Werte für die Differenzierung von Patienten mit Hoch- und Niedrigrisiko betrugen für SUV_max 11,1 (AUC = 0,757), für SUV_mean 6 (AUC = 0,750), für MTV 6,6 (AUC = 0,838) und für TLG 56,2 (AUC = 0,835). MTV- und TLG-Werte waren unabhängige prognostische Faktoren für das OS, während SUV_max- und SUV_mean-Werte nicht prädiktiv waren.

Schlussfolgerungen Die PET-Parameter sind nützlich, um nichtinvasiv zwischen Risikogruppen bei EK zu unterscheiden. Darüber hinaus können die volumetrischen PET-Parameter prädiktiv für das OS bei EK sein.

Key words

endometrial cancer risk classes - FDG PET CT - SUV_max - MTV - TLG - prognosis

Schlüsselwörter

Risikogruppen bei Endometriumkarzinom - FDG-PET/CT - SUV_max - MTV - TLG, Prognose

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