Prognostic value of 18F-FDG PET in uterine cervical cancer patients with stage IIICr allocated by imaging

Background: The effect on survival of radiographic lymph node metastasis in uterine cervical cancer patients is more important than before, even though its prognostic value not been well investigated. The aim of our study is to evaluate the prognostic potential of 18 F-FDG PET imaging in uterine cervical cancer patients with stage IIICr allocated by imaging. Methods Fifty-five patients with biopsy-proven primary cervical cancer underwent definitive radiation therapy for stages IIB–IVB of the 2018 FIGO 2018 classifications. The prognostic performance of pretreatment 18 F-FDG PET and CT for assessing lymph node metastasis was evaluated by two experienced readers. The PET and CT findings were correlated with the risk of progression-free survival (PFS) and overall survival (OS). Results Kaplan–Meier survival curves showed that PFS was significantly worse in patients with FDG uptake in lymph nodes than in those patients with no FDG uptake (p = 0.003), whereas there was no significant difference in PFS between patients with lymph nodes sized ≥ 1 cm and those sized < 1 cm (p = 0.140). Univariate analysis showed that FDG uptake in lymph nodes was significantly associated with poor PFS (p = 0.006), whereas lymph node size was not significantly associated with poor PFS (p = 0.145). In multivariate analysis, FDG uptake in lymph nodes was significantly associated with poor PFS (p = 0.006) and was an independent prognostic factor for PFS. Conclusions 18 F-FDG PET offers high prognostic value for patients with stage IIICr allocated by imaging, suggesting that 18 F-FDG PET might be useful in clinical staging decisions and thus promote optimal diagnostic and therapeutic strategies.