A score combining baseline neutrophilia and primary tumor SUV peak measured from FDG PET is associated with outcome in locally advanced cervical cancer

Eur J Nucl Med Mol Imaging. 2018 Feb;45(2):187-195. doi: 10.1007/s00259-017-3824-z. Epub 2017 Sep 15.


Purpose: We investigated whether a score combining baseline neutrophilia and a PET biomarker could predict outcome in patients with locally advanced cervical cancer (LACC).

Methods: Patients homogeneously treated with definitive chemoradiation plus image-guided adaptive brachytherapy (IGABT) between 2006 and 2013 were analyzed retrospectively. We divided patients into two groups depending on the PET device used: a training set (TS) and a validation set (VS). Primary tumors were semi-automatically delineated on PET images, and 11 radiomics features were calculated (LIFEx software). A PET radiomic index was selected using the time-dependent area under the curve (td-AUC) for 3-year local control (LC). We defined the neutrophil SUV grade (NSG = 0, 1 or 2) score as the number of risk factors among (i) neutrophilia (neutrophil count >7 G/L) and (ii) high risk defined from the PET radiomic index. The NSG prognostic value was evaluated for LC and overall survival (OS).

Results: Data from 108 patients were analyzed. Estimated 3-year LC was 72% in the TS (n = 69) and 65% in the VS (n = 39). In the TS, SUVpeak was selected as the most LC-predictive biomarker (td-AUC = 0.75), and was independent from neutrophilia (p = 0.119). Neutrophilia (HR = 2.6), high-risk SUVpeak (SUVpeak > 10, HR = 4.4) and NSG = 2 (HR = 9.2) were associated with low probability of LC in TS. In multivariate analysis, NSG = 2 was independently associated with low probability of LC (HR = 7.5, p < 0.001) and OS (HR = 5.8, p = 0.001) in the TS. Results obtained in the VS (HR = 5.2 for OS and 3.5 for LC, p < 0.02) were promising.

Conclusion: This innovative scoring approach combining baseline neutrophilia and a PET biomarker provides an independent prognostic factor to consider for further clinical investigations.

Keywords: Biomarkers; Brachytherapy; Cervical carcinoma; Neutrophilia; Prognostic factor; Radiomics.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biological Transport
  • Brachytherapy
  • Chemoradiotherapy
  • Female
  • Fluorodeoxyglucose F18 / metabolism*
  • Humans
  • Image Processing, Computer-Assisted
  • Middle Aged
  • Neoplasm Grading
  • Neutrophils / immunology*
  • Positron-Emission Tomography*
  • Prognosis
  • Retrospective Studies
  • Uterine Cervical Neoplasms / diagnostic imaging*
  • Uterine Cervical Neoplasms / metabolism*
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy


  • Fluorodeoxyglucose F18