The Prognostic Value of the Metabolic Tumor Volume in FIGO stage IA to IIB Cervical Cancer for Tumor Recurrence: Measured by F-18 FDG PET/CT

Purpose The purpose of this study was to evaluate the prognostic value of the metabolic tumor volume (MTV), in FIGO stage IA-IIB cervical cancer patients, measured by F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) imaging. Methods Forty-five patients with invasive cervical cancerwho underwent FDG-PET imaging were recruited. Metabolically active tumor regions were delineated on the pretreatment FDG-PET scans by encompassing regions equal to or greater than an standardized uptake value (SUV) of 40% of the peak tumor intensity. The relationship of the metabolic tumor volume (MTV) to the disease-free survival was analyzed. The MTV of the cervical cancer was compared with pathological and clinical prognostic factors, including lymph node metastasis, parametrial invasion, the depth of invasion, resection margins, tumor differentiation and FIGO stages. Results Cox proportional hazard regression analysis showed that the MTV was a significant independent predictor of recurrence of cervical cancer (p=0.027). Patients with an MTV of > 20 cm(3) had a significantly reduced disease-free survival compared with patients with an MTV=20 cm(3) (p=0.029). The correlation of the MTV with traditional prognostic factors showed significantly higher values in patients that were lymph node (LN) metastasis positive (p=0.028) and parametrial invasion positive (p=0.022). The MTV significantly differed among the groups according to tumor differentiation (p=0.0319) and FIGO stage (p=0.001). Conclusion The MTV measured by FDG-PET was an independent prognostic factor for tumor recurrence in patients with stage IA-IIB cervical cancer. These findings must be confirmed by large population based prospective studies.