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Original Article
Available online 28 May 2021
A systematic review about the role of preoperative 18F-FDG PET/CT for prognosis and risk stratification in patients with endometrial cancer
Revisión sistemática sobre el papel de la 18F-FDG PET/TC preoperatoria para el pronóstico y la estratificación de riesgo en pacientes con cáncer de endometrio
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Edel Noriega-Álvareza,c,
Corresponding author
edelnoriega@gmail.com

Corresponding author at: Nuclear Medicine Department, University Hospital of Ciudad Real, Obispo Rafael Torija, s/n, 13005 Ciudad Real, Spain.
, Ana M. García Vicentea,b, Germán A. Jiménez Londoñoa, Wilson R. Martínez Bravoa, Beatriz González Garcíaa, Ángel M. Soriano Castrejóna
a Nuclear Medicine Department, University Hospital of Ciudad Real
b SEMNIM Oncology Task Group
c SEMNIM Musculoeskeletal Pathology Task Group/EANM Inflammation & Infection Committee
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Table 1. Preoperative prognostic role of 18F-FDG PET in endometrial cancer.
Table 2. Preoperative risk stratification potential of 18F-FDG PET in endometrial cancer.
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Abstract
Objective

To analyse the available literature on the prognostic value of preoperative 18F-FDG PET/CT metabolic parameters and their usefulness in risk stratification in patients with endometrial cancer (EC).

Material and methods

Pubmed searches used “(endometr* OR uter*) AND (PET OR FDG)” as keywords from January-2000 to June-2020. References in included articles were checked for possible publications not included in the first search. Studies evaluating the prognostic value of preoperative 18F-FDG PET/CT and its role for risk stratification in patients with EC were included. Non-original articles (reviews, editorials, letters, legal cases, interviews, case reports, etc.) were not included.

Results

Twenty-six studies (1918 patients) were selected according to the inclusion criteria in this review. Thirteen studies (939 patients) related to the prognostic role of preoperative 18F-FDG PET/CT and 14 studies (1036 patients) related to its role in risk stratification were included. Parameters such as SUVmax, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the primary tumour were analysed.

Conclusions

Preoperative SUVmax is useful for non-invasive diagnosis and for deciding the appropriate therapeutic strategy, as it could be used as an independent prognostic marker for recurrence and survival in EC. In addition, both preoperative VTM and GTL could be independent prognostic factors for predicting recurrence and survival, but there is still insufficient scientific evidence. The usefulness of SUVmax for risk stratification is limited (there is insufficient literature that 18F-FDG PET/CT can replace surgical staging), although VTM and GTL are more accurate and have a valuable role in risk stratification of EC. However, larger multicentre studies with adequate follow-up time are needed to confirm these findings.

Keywords:
Endometrial cancer
Preoperative 18F-FDG PET
SUVmax
Prognosis
Risk-stratification
Systematic review
Resumen
Objetivo

Analizar la literatura disponible sobre el valor pronóstico de los parámetros metabólicos de la 18F-FDG PET/TC preoperatoria y su utilidad en la estratificación de riesgo en pacientes con cáncer endometrial (CE).

Material y métodos

En búsquedas de Pubmed se utilizó “(endometr* OR uter*) AND (PET OR FDG)” como palabras clave desde enero-2000 hasta junio-2020. Se revisaron referencias en los artículos incluidos buscando posibles publicaciones no incluidas en la primera búsqueda. Se incluyeron los estudios que evaluaron el valor pronóstico de la 18F-FDG PET/TC preoperatoria y su papel para la estratificación del riesgo en pacientes con CE. Los artículos no originales (revisiones, editoriales, cartas, casos legales, entrevistas, informes de casos, etc.) no fueron incluidos.

Resultados

Veintiséis estudios (1918 pacientes) fueron elegidos según los criterios de inclusión en esta revisión. Se incluyeron 13 estudios (939 pacientes) relacionados con el papel pronóstico de la 18F-FDG PET/CT preoperatoria y 14 estudios (1036 pacientes) relacionados con su papel en la estratificación de riesgo. Parámetros como SUVmax, volumen tumoral metabólico (VTM) y glicólisis total de lesión (GTL) del tumor primario fueron analizados.

Conclusiones

El SUVmax preoperatorio es útil para realizar diagnósticos no invasivos y decidir la estrategia terapéutica adecuada, ya que podría utilizarse como marcador pronóstico independiente de recurrencia y supervivencia en el CE. Además, tanto VTM como GTL preoperatorios podrían ser factores pronósticos independientes para predecir recurrencia y supervivencia, pero aun no existe suficiente evidencia científica. La utilidad del SUVmax para la estratificación del riesgo es limitada (no existe literatura suficiente acerca de que la 18F-FDG PET/TC pueda sustituir la estadificación quirúrgica), aunque el VTM y la GTL si que son más precisos y tienen un valioso papel en la estratificación del riesgo del CE. Sin embargo, se necesitan estudios multicéntricos más amplios con un tiempo de seguimiento adecuado para confirmar estos hallazgos.

Palabras clave:
Cáncer de endometrio
18F-FDG PET preoperatorio
SUVmax
Pronóstico
Estratificación de riesgo
Revisión sistemática

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