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Nuklearmedizin 2021; 60(01): 16-24
DOI: 10.1055/a-1267-8976
Original Article

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

Nutzen von PET-Parametern für die Vorhersage von Risikogruppen bei Endometriumkarzinom und dessen Prognose
Adnan Budak
1   Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
,
Emrah Beyan
1   Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
,
Abdurrahman Hamdi Inan
1   Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
,
Ahkam Göksel Kanmaz
1   Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
,
Onur Suleyman Aldemir
2   Department of Obstetrics and Gynecology, Ministry of Health, Izmir, Turkey
,
Aylin Oral
3   Department of Nuclear Medicine, Ege University, Izmir, Turkey
,
Bulent Yazici
3   Department of Nuclear Medicine, Ege University, Izmir, Turkey
,
Ayşegül Akgün
3   Department of Nuclear Medicine, Ege University, Izmir, Turkey
,
Mehmet Ozeren
1   Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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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 (SUVmax, SUVmean, 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 SUVmax (AUC = 0.757), 6 for SUVmean (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 SUVmax and SUVmean 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 (SUVmax, SUVmean, 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 SUVmax 11,1 (AUC = 0,757), für SUVmean 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 SUVmax- und SUVmean-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 - SUVmax - MTV - TLG - prognosis

Schlüsselwörter

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


Publication History

Received: 04 March 2020

Accepted: 03 September 2020

Article published online:
26 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kitajima K, Suenaga Y, Ueno Y. et al. Preoperative risk stratification using metabolic parameters of F-FDG PET/CT in patients with endometrial cancer. Eur J Nucl Med Mol Imaging 2015; 42: 1268-1275
    CrossrefPubMedGoogle Scholar
  • 2 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and majör patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: 359-386
    CrossrefPubMedGoogle Scholar
  • 3 Cornelison TL, Trimble EL, Kosary CL. SEER data, corpus uteri cancer: treatment trends versus survival for FIGO stage II, 1988–1994. Gynecol Oncol 1999; 74: 350-355
    CrossrefPubMedGoogle Scholar
  • 4 Creutzberg CL, van Putten WL, Koper PC. et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 2000; 355: 1404-1411
    CrossrefPubMedGoogle Scholar
  • 5 Colombo N, Creutzberg C, Amant F. et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer 2016; 26: 2-30
    CrossrefPubMedGoogle Scholar
  • 6 Galaal K, Al Moundhri M, Bryant A. et al. Adjuvant chemotherapy for advanced endometrial cancer. Cochrane Database Syst Rev 2014; 5: CD010681
    Google Scholar
  • 7 Di Cello A, Rania E, Zuccala V. et al. Failure to recognize preoperatively high-risk endometrial carcinoma is associated with a poor outcome. Eur J Obstet Gynecol Reprod Biol 2015; 194: 153-160
    CrossrefPubMedGoogle Scholar
  • 8 Imai K, Kato H, Katayama K. et al. A preoperative risk-scoring system to predict lymph node metastasis in endometrial cancer and stratify patients for lymphadenectomy. Gynecol Oncol 2016; 142: 273-277
    CrossrefPubMedGoogle Scholar
  • 9 Mariani A, Dowdy SC, Cliby WA. et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 2008; 109: 11-18
    CrossrefPubMedGoogle Scholar
  • 10 AlHilli MM, Mariani A, Bakkum-Gamez JN. et al. Risk-scoring models for individualized prediction of overall survival in low-grade and high-grade endometrial cancer. Gynecol Onco 2014; 133: 485-493
    CrossrefPubMedGoogle Scholar
  • 11 Kang S, Lee JM, Lee JK. et al. A Web-based nomogram predicting para-aortic nodal metastasis in incompletely staged patients with endometrial cancer: a Korean multicenter study. Int J Gynecol Cancer 2014; 24: 513-519
    CrossrefPubMedGoogle Scholar
  • 12 Keys HM, Roberts JA, Brunetto VL. et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a gynecologic oncology group study. Gynecol Oncol 2004; 92: 744-751
    CrossrefPubMedGoogle Scholar
  • 13 Barlin JN, Soslow RA, Lutz M. et al. Redefining stage I endometrial cancer: incorporating histology, a binary grading system, myometrial invasion, and lymph node assessment. Int J Gynecol Cancer 2013; 23: 1620-1628
    CrossrefPubMedGoogle Scholar
  • 14 Kong TW, Chang SJ, Paek J. et al. Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the gynecologic oncology group criteria. J Gynecol Oncol 2015; 26: 32-39
    CrossrefPubMedGoogle Scholar
  • 15 Kwon JS, Qiu F, Saskin R. et al. Are uterine risk factors more important than nodal status in predicting survival in endometrial cancer?. Obstet Gynecol 2009; 114: 736-743
    CrossrefPubMedGoogle Scholar
  • 16 Bendifallah S, Canlorbe G, Collinet P. et al. Just how accurate are the major risk stratification systems for early-stage endometrial cancer?. Br J Cancer 2015; 112: 793-801
    CrossrefPubMedGoogle Scholar
  • 17 Talhouk A, McAlpine JN. New classification of endometrial cancers: the development and potential applications of genomic-based classification in research and clinical care. Gynecol Oncol Res Pract 2016; 3: 14
    CrossrefPubMedGoogle Scholar
  • 18 Haldorsen IS, Salvesen HB. Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques. Clin Radiol 2012; 67: 2-12
    CrossrefPubMedGoogle Scholar
  • 19 Haldorsen IS, Husby JA, Werner HM. et al. Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists. Eur Radiol 2012; 22: 1601-1611
    CrossrefPubMedGoogle Scholar
  • 20 Chang MC, Chen JH, Liang JA. et al. 18F-FDG PET or PET/CT for detection of metastatic lymph nodes in patients with endometrial cancer: a systematic review and meta-analysis. Eur J Radiol 2012; 81: 3511-3517
    CrossrefPubMedGoogle Scholar
  • 21 Crivellaro C, Signorelli M, Guerra L. et al. Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer: the role of 18F-FDG PET/CT. Gynecol Oncol 2013; 130: 306-311
    CrossrefPubMedGoogle Scholar
  • 22 Horowitz NS, Dehdashti F, Herzog TJ. et al. Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol 2004; 95: 546-551
    CrossrefPubMedGoogle Scholar
  • 23 Suzuki R, Miyagi E, Takahashi N. et al. Validity of positron emission tomography using fluoro-2-deoxyglucose for the preoperative evaluation of endometrial cancer. Int J Gynecol Cancer 2007; 17: 890-896
    CrossrefPubMedGoogle Scholar
  • 24 Lee HJ, Ahn BC, Hong CM. et al. Preoperative risk stratification using 18FFDG PET/CT in women with endometrial cancer. Nuklearmedizin 2011; 50: 204-213
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Shim SH, Kim DY, Lee DY. et al. Metabolic tumour volume and total lesion glycolysis, measured using preoperative 18F-FDG PET/CT, predict the recurrence of endometrial cancer. BJOG 2014; 121: 1097-1106
    CrossrefPubMedGoogle Scholar
  • 26 Walentowicz-Sadlecka M, Malkowski B, Walentowicz P. et al. The preoperative maximum standardized uptake value measured by 18F-FDG PET/CT as an independent prognostic factor of overall survival in endometrial cancer patients. Biomed Res Int 2014; 2014: 234813
    CrossrefPubMedGoogle Scholar
  • 27 Antonsen SL, Loft A, Fisker R. et al. SUVmax of 18FDG PET/CT as a predictor of high-risk endometrial cancer patients. Gynecol Oncol 2013; 129: 298-303
    CrossrefPubMedGoogle Scholar
  • 28 Akin EA, Kuhl ES, Zeman RK. The role of FDG-PET/CT in gynecologic imaging: an updated guide to interpretation and challenges. Abdom Radiol 2018; 43: 2474-2486
    CrossrefPubMedGoogle Scholar
  • 29 NCCN Practice Guidelines Narrative Summary of Indications for FDG PET and PET/ CT. 2/14/2016 ed2016.
    Google Scholar
  • 30 Boellaard R, O'Doherty MJ, Weber WA. et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 2010; 37: 181-200
    CrossrefPubMedGoogle Scholar
  • 31 Colombo N, Creutzberg C, Amant F. et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2016; 27: 16-41
    CrossrefPubMedGoogle Scholar
  • 32 Kitajima K, Kita M, Suzuki K. et al. Prognostic significance of SUVmax (maximum standardized uptake value) measured by [(1)(8)F] FDG PET/CT in endometrial cancer. Eur J Nucl Med Mol Imaging 2012; 39: 840-845
    CrossrefPubMedGoogle Scholar
  • 33 Nakamura K, Kodama J, Okumura Y. et al. The SUVmax of 18F-FDG PET correlates with histological grade in endometrial cancer. Int J Gynecol Cancer 2010; 20: 110-115
    CrossrefPubMedGoogle Scholar
  • 34 Torizuka T, Nakamura F, Takekuma M. et al. FDG PET for the assessment of myometrial infiltration in clinical stage I uterine corpus cancer. Nucl Med Commun 2006; 27: 481-487
    CrossrefPubMedGoogle Scholar
  • 35 Ghooshkhanei H, Treglia G, Sabouri G. et al. Risk stratification and prognosis determination using (18)F-FDG PET imaging in endometrial cancer patients: a systematic review and meta-analysis. Gynecol Oncol 2014; 132: 669-676
    CrossrefPubMedGoogle Scholar
  • 36 Husby JA, Reitan BC, Biermann M. et al. Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients. J Nucl Med 2015; 56: 1191-1198
    CrossrefPubMedGoogle Scholar
  • 37 Adams MC, Turkington TG, Wilson JM. et al. A systematic review of the factors affecting accuracy of SUV measurements. Am J Roentgenol 2010; 195: 310-320
    CrossrefPubMedGoogle Scholar
  • 38 Brendle C, Kupferschläger J, Nikolaou K. et al. Is the standard uptake value (SUV) appropriate for quantification in clinical PET imaging? – Variability induced by different SUV measurements and varying reconstruction methods. Eur J Radiol 2015; 84: 158-162
    CrossrefPubMedGoogle Scholar
  • 39 Sher A, Lacoeuille F, Fosse P. et al. For avid glucose tumors, the SUV peak is the most reliable parameter for [(18)F]FDG-PET/CT quantification, regardless of acquisition time. EJNMMI Res 2016; 6: 21
    CrossrefPubMedGoogle Scholar
  • 40 Ziai P, Hayeri MR, Salei A. et al. Role of Optimal Quantification of FDG PET Imaging in the Clinical Practice of Radiology. Radiographics 2016; 36: 481-496
    CrossrefPubMedGoogle Scholar
  • 41 Lee HY, Hyun SH, Lee KS. et al. Volume-based parameter of 18F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications. Ann Surg Oncol 2010; 17: 2787-2794
    CrossrefPubMedGoogle Scholar