Splenic 18F-FDG uptake on baseline PET/CT is associated with oncological outcomes and tumor immune state in uterine cervical cancer.
Gynecol Oncol
; 159(2): 335-343, 2020 11.
Article
em En
| MEDLINE
| ID: mdl-32859399
ABSTRACT
OBJECTIVE:
The spleen represents an important contributor to tumor immune escape, but the relevance of increased splenic metabolic activity remains to be fully elucidated.METHODS:
We retrospectively measured the spleen-to-liver standard uptake value (SLR) on 18F-FDG PET/CT examinations of 92 consecutive patients with FIGO stage IB1 to IVA cervical cancer and integrated the results with survival, response to treatment, tumor immune infiltrate, and baseline characteristics.RESULTS:
SLRmaxâ¯>â¯0.92 (pâ¯=â¯.026) and SLRmeanâ¯>â¯0.94 (pâ¯=â¯.005) were significantly associated with decreased DFS in univariable analysis. Multivariable models were built using best subset selection; ΔSLRmax and either SLRmax or SLRmean were consistently selected, strongly reinforcing the association between SLR variables and DFS in relation to potential confounders (all models pâ¯≤â¯.002). Independent associations were found for SLRmax using multivariable Cox regression models for DFS (all pâ¯≤â¯.003). Further, uni- and multivariable analyses demonstrated the negative impact of higher SLR values on pathological complete response. A statistically significant higher proportion of patients with high SLRmax had a dense infiltrate of CD20+ (pâ¯=â¯.036) and CD68+ (pâ¯=â¯.015) immune cells, as well as PD-L1+ tumor cells (pâ¯=â¯.019) as compared to those with low SLRmax. Finally, high SLRmax status was neither associated with systemic inflammatory markers (except for an increased white blood cell count; pâ¯=â¯.038), nor with clinically overt infection.CONCLUSION:
This hypothesis-generating study provides the first evidence that increased splenic metabolic activity is a negative prognostic and predictive biomarker in locally advanced cervical cancer. In addition, it might help to discriminate immunologically 'hot' from 'cold' cervical tumors.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Baço
/
Neoplasias do Colo do Útero
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Fluordesoxiglucose F18
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Middle aged
Idioma:
En
Revista:
Gynecol Oncol
Ano de publicação:
2020
Tipo de documento:
Article