Preoperative PET/CT standardized FDG uptake values of pelvic lymph nodes as a significant prognostic factor in patients with endometrial cancer

Using integrated PET/CT, we evaluated the prognostic relevance of preoperative pelvic lymph node (LN) 18F-FDG uptake in endometrioid endometrial cancer. We retrospectively reviewed patients with pathologically proven endometrial cancer who underwent preoperative 18F-FDG PET/CT scans to evaluate the prognostic significance of PET/CT parameters and other clinicopathological variables. We used Cox proportional hazards regression to examine the relationship between recurrence and the maximum standardized uptake value (SUVmax) in pelvic LNs (SUVLN) on FDG PET/CT. Clinical data, treatment modalities and results were reviewed in 70 eligible patients. The median postsurgical follow-up was 29 months (range 6 to 95 months). Receiver-operating characteristic analysis identified the significant SUVLN cut-off value as 15. The SUVLN correlated with FIGO stage (P < 0.001), LN metastasis (P < 0.001), lymphovascular space invasion (P < 0.001), SUVtumour (P = 0.001), metastatic LN size (P = 0.004), primary tumour size (P = 0.012), tumour grade (P = 0.015) and depth of tumour invasion (P = 0.035). Regression analysis showed a statistically significant association between recurrence and SUVLN (P = 0.002). Recurrence differed significantly (P < 0.001) between patients with SUVLN >15 and those with SUVLN ≤15. Preoperative pelvic LN FDG uptake exhibited a strong significant association with recurrence of endometrioid endometrial cancer. (orig.)