Prognostic value of total lesion glycolysis on preoperative ¹⁸F-FDG PET/CT in patients with uterine carcinosarcoma

Objectives: To investigate the relationship between functional tumour parameters measured during preoperative ¹⁸F-FDG PET/CT and clinical outcomes in patients with uterine carcinosarcoma. Methods: For patients with pathologically proven uterine carcinosarcoma, we determined the maximal and average standardized uptake values, cumulative total lesion glycolysis (TLG) and sum of all metabolic tumour volumes (MTVs). Their predictive value for recurrence and the effects of pretreatment functional tumour activity on patient survival were compared. Results: Clinicopathological data from 28 eligible patients were reviewed. The median duration of progression-free survival was 18.6 months (range 6.1–84.5 months), and 10 (35.7 %) patients experienced recurrences. Univariate analyses showed significant associations between recurrence and tumour size, lymph node metastasis, high TLG and MTV values, and ovarian invasion. Multivariate analysis identified high TLG value as an independent risk factor for recurrence (p = 0.048, hazard ratio 115.261, 95 % confidence interval 1.041–12,765.483). Kaplan–Meier survival curves showed that progression-free survival significantly differed in groups categorized according to TLG (p = 0.007, log-rank test). Conclusions: Preoperative TLG measured with ¹⁸F-FDG PET/CT was statistically significantly associated with uterine carcinosarcoma recurrence. Metabolic parameters can provide useful quantitative criteria for disease prognostication in patients with uterine carcinosarcoma before treatment. Key Points: • Preoperative TLG was an independent risk factor for recurrence in uterine carcinosarcoma. • Progression-free survival significantly differed in groups categorized by TLG. • Metabolic parameters can provide useful quantitative criteria for disease prognostication.