Relationship Between 18F-FDG PET/CT Parameters and Clinical Characteristics of Intermediate-Stage Cervical Cancer and Their Predictive Value for Postoperative Recurrence

WANG Su; ZHU Li; YAO Nuan; SHANG Yu

doi:10.3969/j.issn.1004-437X.2025.16.015

Abstract：Objective To explore the relationship between the parameters of 18F-fluorodeoxyglucose positron emission tomography(18 F-FDG PET/CT)and the clinical characteristics of intermediate-stage cervical cancer,as well as its predictive value for postoperative recurrence.Methods A total of 196 cases of cervical cancer undergoing elective surgery at Nanyang Central Hospital from August 2019 to August 2022 were selected.Before surgery,all patients underwent 18F-FDG PET/CT examination to obtain quantitative parameters[total lesion glycolysis(TLG),metabolic volume(MTV),and maximum standardized uptake value(SUVmax)].After a 2-year follow-up,patients were divided into recurrence group and non-recurrence group according to the recurrence status after surgery.The 18F-FDG PET/CT parameters of patients with different clinical characteristics were compared.The correlation between 18F-FDG PET/CT parameters and clinical characteristics of intermediate-stage cervical cancer was analyzed.The general preoperative data and18 F-FDG PET/CT parameters of patients in the recurrent group and non-recurrent group were compared.The influencing factors of postoperative recurrence were analyzed.The value of 18F-FDG PET/CT parameters in predicting postoperative recurrence was analyzed.The conventional influencing factors were combined to construct a conventional prediction model.Conventional prediction models were combined with 18F-FDG PET/CT parameters to construct a new prediction model.The value of predicting postoperative recurrence was compared between the two models.Results The TLG,MTV,and SUVmax in patients with low differentiation were higher than those in patients with medium and high differentiation.The TLG,MTV,and SUVmax in patients with a tumor maximum diameter of ≥4 cm were higher than those in patients with a tumor maximum diameter of＜4 cm.The TLG,MTV,and SUVmax in patients with Federation International of Gynecology and Obstetrics(FIGO)stage Ⅱ were higher than those in patients with FIGO stage Ⅰ B2(P＜0.05).In patients with intermediate-stage cervical cancer,TLG,MTV,and SUVmax were negatively correlated with the degree of differentiation,while they were positively correlated with the maximum tumor diameter and FIGO stage(P＜0.05).During the follow-up period after surgery,a total of 8 patients were lost to follow-up.Among the patients who completed the follow-up,the recurrence group had a higher proportion of lower differentiation degree,(a maximum tumor diameter of ≥4 cm,FIGO stage Ⅱ,and higher preoperative serum carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA)levels,TLG,MTV,and SUVmax than the non-recurrence group(P＜0.05).Preoperative serum CA125,CEA levels,TLG,MTV,and SUVmax were all independent risk factors for postoperative recurrence in patients with intermediate-stage cervical cancer(P＜0.05).The area under the curve(AUC)of preoperative TLG,MTV,and SUVmax for predicting the recurrence of intermediate-stage cervical cancer patients after surgery were 0.742,0.746,and 0.755,respectively.The AUC of the conventional prediction model(preoperative serum CA125 and CEA combined)for predicting the recurrence of intermediate-stage cervical cancer patients after surgery was 0.819,while the AUC of the new prediction model for predicting the recurrence of intermediate-stage cervical cancer patients after surgery was 0.909,and the AUC of the new prediction model was greater than that of the conventional prediction model(P＜0.05).Conclusion The parameters of 18F-FDG PET/CT,such as TLG,MTV,and SUVmax are closely related to the degree of differentiation,the maximum tumor diameter,and the FIGO stage in patients with intermediate-stage cervical cancer,and have certain predictive power in predicting postoperative recurrence.