Risk stratification and prognosis determination using 18F-FDG PET imaging in endometrial cancer patients: A systematic review and meta-analysis

Research highlights•Prognostic importance of 18-F-FDG PET in endometrial cancer is reviewed.•Pooled average SUVmax was higher in high risk patients vs. low risk ones.•Pooled HR of pre-operative SUVmax for disease free survival was 7.415.

ObjectivesIn the current study, we systematically searched and analyzed the available literature on the prognostic value of semi-quantitative 18F-FDG PET imaging (SUVmax/mean) in patients with endometrial cancer and presenting the results in a meta-analytic format.MethodsPubmed, SCOPUS, and ISI Web of Knowledge were searched using “endometr* AND PET” as the search algorithm. All studies evaluating the 18F-FDG PET performance in pre-operative risk stratification or its prognostic value in patients with endometrial cancer were included. Statistical pooling of diagnostic accuracy indices was performed using random effects model. Cochrane Q test and I2 index were used for heterogeneity evaluation.ResultsTen studies (771 patients) were included in the systematic review. Pooled average SUVmax values in patients with risk factors [grade III, lymphovascular invasion (LVI), cervical invasion (CI), myometrial invasion (MI) ≥ 50%] were statistically higher than those in patients without risk factors. Pooled HR of pre-operative SUVmax for disease free survival was 7.415 [2.892-19.432] (p = 0.000046).ConclusionDespite higher average SUVmax in the high-risk group compared to the low-risk group of patients with endometrial cancer, the usefulness of 18F-FDG PET SUVmax in classifying patients into pre-defined risk groups seems to be limited. However, pre-operative SUVmax of endometrial tumors seems to be an independent prognostic marker of recurrence and death. Further large multicenter studies with adequate follow-up are needed to confirm our findings.