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

다국어 초록 (Multilingual Abstract)

Objective: To determine whether [^(18)F]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 (SUV_location 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 SUV_location 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. ≥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.

다국어 초록 (Multilingual Abstract)

Objective: To determine whether [^(18)F]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 (SUV_location 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 SUV_location 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. ≥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.

참고문헌 (Reference)

1 Eisenkop SM, "“Optimal” cytoreduction for advanced epithelial ovarian cancer: a commentary" 103 : 329-335, 2006

2 Kim S, "[18F]FDG PET as a substitute for second-look laparotomy in patients with advanced ovarian carcinoma" 31 : 196-201, 2004

3 Chi DS, "What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)?" 103 : 559-564, 2006

4 Hoskins WJ, "The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study" 47 : 159-166, 1992

5 Chung HH, "The clinical impact of [(18)F]FDG PET/CT for the management of recurrent endometrial cancer: correlation with clinical and histological findings" 35 : 1081-1088, 2008

6 Bristow RE, "Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis" 20 : 1248-1259, 2002

7 Griffiths CT., "Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma" 42 : 101-104, 1975

8 Chung HH, "Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological fin" 34 : 480-486, 2007

9 Prakash P, "Role of PET/CT in ovarian cancer" 194 : 464-470, 2010

10 Wimberger P, "Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival: an exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR)" 106 : 69-74, 2007

11 Avril N, "Prediction of response to neoadjuvant chemotherapy by sequential F-18-fluorodeoxyglucose positron emission tomography in patients with advanced-stage ovarian cancer" 23 : 7445-7453, 2005

12 Naik R, "Optimal cytoreductive surgery is an independent prognostic indicator in stage IV epithelial ovarian cancer with hepatic metastases" 78 : 171-175, 2000

13 Park TW, "Neoadjuvant chemotherapy in ovarian cancer" 4 : 639-647, 2004

14 Nishiyama Y, "Monitoring the neoadjuvant therapy response in gynecological cancer patients using FDG PET" 35 : 287-295, 2008

15 Sironi S, "Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histologic findings" 233 : 433-440, 2004

16 Soussan M, "Impact of FDG PET-CT imaging on the decision making in the biologic suspicion of ovarian carcinoma recurrence" 108 : 160-165, 2008

17 Crawford SC, "Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial" 23 : 8802-8811, 2005

18 Cormio G, "Distant metastases in ovarian carcinoma" 13 : 125-129, 2003

19 Kitajima K, "Diagnostic accuracy of integrated FDG-PET/contrast- enhanced CT in staging ovarian cancer: comparison with enhanced CT" 35 : 1912-1920, 2008

20 Dirisamer A, "Detection of histologically proven peritoneal carcinomatosis with fused 18F-FDG-PET/MDCT" 69 : 536-541, 2009

21 Heintz AP, "Cytoreductive surgery in ovarian carcinoma: feasibility and morbidity" 67 : 783-788, 1986

22 Heintz AP, "Carcinoma of the ovary: FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer" 95 (95): 161-192, 2006

23 Jemal A, "Cancer statistics, 2009" 59 : 225-249, 2009

24 Aletti GD, "Analysis of factors impacting operability in stage IV ovarian cancer: rationale use of a triage system" 105 : 84-89, 2007

25 Townsend DW, "A combined PET/CT scanner: the path to true image fusion" 75 : 24-30, 2002