Complementary Prognostic Value of Pelvic Magnetic Resonance Imaging and Whole-Body Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Pretreatment Assessment of Patients With Cervical Cancer. Issue 8 (October 2015)

• Record Type: Journal Article
• Authors: Sala, Evis; Micco, Maura; Burger, Irene A.; Yakar, Derya; Kollmeier, Marisa A.; Goldman, Debra A.; Gonen, Mithat; Park, Kay J.; Abu-Rustum, Nadeem R.; Hricak, Hedvig; Vargas, Hebert Alberto
• Is Part Of: International journal of gynecological cancer. Volume 25:Issue 8(2015:Oct.)
• Publication Date: 2015-10
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0000000000000519
• Languages: English
• ISSNs: 1048-891X

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective</title> <p>The aim of this study was to evaluate the incremental prognostic value of pelvic magnetic resonance imaging (MRI) and whole-body <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings compared with clinical-histopathologic factors in patients with newly diagnosed cervical cancer.</p> </sec> <sec> <title>Methods</title> <p>The institutional review board approved this retrospective study of 114 patients (median age, 40.6 years) with International Federation of Gynecology and Obstetrics (FIGO) stage I-IVB cervical cancer who underwent pretreatment MRI and PET/CT. All scans were reviewed for locoregional tumor extent, pelvic or/and para-aortic lymphadenopathy, and distant metastases. Univariate Cox proportional hazard regression was performed to evaluate associations between clinical-histopathologic factors, imaging findings, and progression-free survival (PFS). Multivariate models were built using independent predictors for PFS. Harrell <italic>C</italic> was used to measure concordance (<italic>C</italic> index).</p> </sec> <sec> <title>Results</title> <p>Forty patients progressed within a median time of 10.4 months (range, 0.4–40.3 months). At univariate analysis, age, FIGO stage, tumor histology, tumor grade, and all MRI and PET/CT features were significantly associated with PFS (<italic>P</italic> < 0.0001 to <italic>P</italic> = 0.0474). A multivariate model including clinical and imaging parameters (parametrial invasion on MRI and para-aortic lymphadenopathy/distant metastases on PET/CT) had significantly higher concordance for predicting PFS than a model including clinical parameters only (<italic>C</italic> index: 0.81 [95% confidence interval, 0.75–0.87] vs 0.68 [95% confidence interval, 0.59–0.78]; <italic>P</italic> < 0.001). The comparison of <italic>C</italic> indices for the combined clinical and imaging model approached significance when compared with a FIGO stage model (<italic>C</italic> index: 0.81 [95% confidence interval, 0.75–0.87] vs 0.75 [95% confidence interval, 0.69–0.82]; <italic>P</italic> = 0.058).</p> </sec> <sec> <title>Conclusions</title> <p>In patients with newly diagnosed cervical cancer, a prognostic model including combined MRI and PET/CT findings provides information that complements clinical and histopathologic factors.</p> </sec> </abstract>