J Gynecol Oncol.  2017 May;28(3):e28. 10.3802/jgo.2017.28.e28.

Prognostic significance of preoperative ¹⁸F-FDG PET/CT in uterine leiomyosarcoma

Affiliations
  • 1Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 2Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 4Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 6Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. chhkmj@gmail.com

Abstract


OBJECTIVE
Uterine leiomyosarcoma (LMS) is a rare and aggressive disease with poor outcome. Due to its rarity and conflict of data, investigation on finding prognostic factor is challenging. The aim of the study was to investigate the prognostic significance of preoperative ¹â¸F-fluorodeoxyglucose (¹â¸F-FDG) positron emission tomography/computed tomography (PET/CT) in uterine LMS.
METHODS
This was a retrospective observational cohort study in 3 tertiary referral hospitals. We retrospectively evaluated data from patients with pathologically proven uterine LMS who underwent preoperative ¹â¸F-FDG PET/CT scans at 3 institutions. The prognostic implication of PET/CT parameters and other clinico-pathological parameters on disease-free survival (DFS) and overall survival (OS) was evaluated.
RESULTS
Clinico-patholgical data were reviewed for 19 eligible patients. In the group overall, median DFS and OS were 12 and 20 months, respectively. As for the recurrence, large tumor size, and high tumor maximum standardized uptake value (SUVmax) were demonstrated as risk factors of recurrence. As for the OS, high tumor SUVmax was demonstrated as the unique risk factor. There were significant differences in tumor size, mitotic count, SUVmax, and DFS between patients with and without recurrence. Also, there were significant differences in tumor size, SUVmax, DFS, and OS between 2 subgroups stratified by cut-off SUVmax.
CONCLUSION
SUVmax at preoperative ¹â¸F-FDG PET/CT was associated with worse outcome in patients with uterine LMS. In the preoperative setting, SUVmax can be a valuable non-invasive prognostic marker. Additionally, SUVmax can help identify highly aggressive uterine LMS and may help in adjusting standard treatment toward an individualized, risk-adapted treatment.

Keyword

Uterine Diseases; Leiomyosarcoma; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; SUVmax; Prognosis
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