J Gynecol Oncol.  2012 Jan;23(1):28-34. 10.3802/jgo.2012.23.1.28.

Preoperative [18F]FDG PET/CT predicts recurrence in patients with epithelial ovarian cancer

• Chung HH
• Kwon HW
• Kang KW
• Kim JW
• Park NH
• Song YS
• Kang SB

• KMID: 2177511
• DOI: http://doi.org/10.3802/jgo.2012.23.1.28

Abstract

OBJECTIVE
To determine whether [18F]FDG uptake on PET/CT imaging before surgical staging has prognostic significance in patients with epithelial ovarian cancer (EOC).
METHODS
Patients with EOC were imaged with integrated PET/CT before surgical staging. Hypermetabolic lesions were measured as the standardized uptake value (SUV) in primary and metastatic tumors. SUV distribution was divided into two regions at the level of umbilicus, and the impact of the ratio between above and below umbilicus (SUVlocation ratio) on progression-free survival (PFS) was examined using Cox proportional hazards regression.
RESULTS
Between January 2004 and December 2009, 55 patients with EOC underwent preoperative PET/CT. The median duration of PFS was 11 months (range, 3 to 43 months), and twenty (36.4%) patients experienced recurrence. In univariate analysis, high SUVlocation ratio (p=0.002; hazard ratio [HR], 1.974; 95% confidence interval [CI], 1.286 to 3.031) was significantly associated with recurrence. Malignant mixed mullerian tumor compared with endometrioid histology was also shown to have significance. In multivariate analysis, high SUVlocation ratio (p=0.005; HR, 2.418; 95% CI, 1.1315 to 4.447) and histology (serous, mucinous, and malignant mixed mullerian tumor compared with endometrioid type) were significantly associated with recurrence. Patients were categorized into two groups according to SUVlocation ratio (<0.3934 vs. > or =0.3934), and the Kaplan-Meier survival graph showed a significant difference in PFS between the groups (p=0.0021; HR, 9.47, log-rank test).
CONCLUSION
SUV distribution showed a significant association with recurrence in patients with EOC, and may be a useful predictor of recurrence.

Keyword

Distribution; Epithelial ovarian cancer; Recurrence; Standardized uptake value

MeSH Terms

Disease-Free Survival
Humans
Mucins
Multivariate Analysis
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms
Recurrence
Umbilicus
Mucins
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms

Figure

• 

  Fig. 1 ROC curve analysis for determination of the cutoff value of the ratio of metabolic standardized uptake value (SUV) location (SUVlocation) ratio according to anatomic location for predicting recurrence. The area under the ROC curve for discriminating recurrence of [18F]FDG PET/CT using the cutoff value of 0.3934 was 0.74 (p=0.004; 95% confidence interval, 0.607 to 0.873).

• 

  Fig. 2 Progression-free survival (PFS) among patients with epithelial ovarian cancer stratified by the ratio of metabolic standardized uptake value (SUV) location (SUVlocation) ratio. Blue line SUVlocation<0.3934, green line SUVlocation≥0.3934. There was statistically significant difference in PFS for patients with SUVlocation less than 0.3934 and SUVlocation≥0.3934 (p=0.0021, log-rank test).

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