Predictive value of preoperative 18F-FDG PET/CT imaging combined with coagulation parameters for recurrence in patients with early cervical cancer / 中华核医学与分子影像杂志

ABSTRACT

Objective:To explore the value of preoperative 18F-fluorodeoxyglucose(FDG) PET/CT parameters combined with coagulation parameters in predicting the recurrence after surgery in patients with early cervical cancer. Methods:A total of 120 patients(age range 25-70 (47.9±8.5) years) with cervical cancer who underwent preoperative 18F-FDG PET/CT examination and blood coagulation index test in Shengjing Hospital of China Medical University between January 2012 and December 2014 were retrospectively analyzed. Patients were divided into recurrent group and non-recurrent group according to the follow-up results. Independent-sample t test or Mann-Whitney U test was used to compare the differences of related parameters between the recurrent and non-recurrent patients. Then the receiver operating characteristic (ROC) curve analysis was performed, and univariate and multivariate Cox analyses were used to evaluate the predictive value of parameters. Results:The follow-up time was 2-60 months. There were 36 recurrent cases, accounting for 30.0% (36/120) of all patients. The mean standardized uptake value (SUV mean), peak of standardized uptake value (SUV peak) and total lesion glycosis (TLG) were significantly different between recurrent ( n=27) and non-recurrent ( n=62) subgroups of moderately differentiated patiens (8.90±3.00 vs 7.50±2.90, 12.00±3.70 vs 10.20±4.50, 144.48(43.79, 366.46) vs 60.23(28.46, 113.15) g; t values 1.968, 2.063, U=547.000, all P<0.05); the maximum standardized uptake value (SUV max), SUV mean, SUV peak, TLG were significantly different between recurrent ( n=7) and non-recurrent ( n=12) subgroups of poorly differentiated patiens (16.10±4.70 vs 7.60±2.33, 8.70±2.10 vs 4.40±1.50, 13.30±4.40 vs 5.60±1.80, 140.37(131.44, 143.94) vs 31.64(15.84, 92.14) g; t values 5.363, 4.829, 5.429, U=3.000, all P<0.05); D-dimer and fibrinogen (FIB) of recurrent and non-recurrent patients were also different (175.00(100.00, 256.00) vs 86.00(51.25, 115.25) mg/L, (3.10±0.50) vs (2.80±0.50) mg/L; U=619.500, t=2.962, both P<0.05). The ROC curve indicated that SUV max (area under curve (AUC)=0.651), SUV mean (AUC=0.650), SUV peak (AUC=0.675), TLG (AUC=0.703), D-dimer (AUC=0.795) and FIB (AUC=0.672) could predict the recurrence of the disease(all P<0.01). Univariate Cox analysis revealed that the International Federation of Gynecology and Obstetrics (FIGO) staging (hazard ratio ( HR)=2.363, 95% CI 1.217-4.590), SUV max ( HR=4.855, 95% CI 1.488-15.841), SUV mean ( HR=4.451, 95% CI 1.573-12.597), SUV peak ( HR=7.190, 95% CI 2.203-23.469), TLG ( HR=4.396, 95% CI 2.238-8.633), D-dimer ( HR=4.761, 95% CI 2.470-9.253) and FIB ( HR=3.196, 95% CI 1.596-6.400) were predictive factors of recurrence (all P<0.05). Multivariate Cox analysis showed that D-dimer ( HR=2.974, 95% CI 1.476-5.990) and SUV peak ( HR=3.826, 95% CI 1.063-13.778) were the main predictors (both P<0.05). ROC curve of SUV peak combined with D-dimer showed the AUC of 0.841( P<0.01). Conclusions:SUV peak and D-dimer are main indexes to evaluate the recurrence after surgery in patients with cervical cancer. SUV peak combined with D-dimer have good predictive value for the recurrence of cervical cancer.