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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 10/2014

01-10-2014 | Original Article

The role of metabolic tumor volume and total lesion glycolysis on 18F-FDG PET/CT in the prognosis of epithelial ovarian cancer

Authors: Jeong Won Lee, Arthur Cho, Jae-Hoon Lee, Mijin Yun, Jong Doo Lee, Young Tae Kim, Won Jun Kang

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2014

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Abstract

Purpose

This study assessed the prognostic value of pre-operative 2-[18F] fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) volumetric parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in patients with epithelial ovarian cancer.

Methods

A total of 175 patients with epithelial ovarian cancer who underwent 18 F-FDG PET/CT and subsequent cytoreductive surgery were retrospectively enrolled. Maximum standardized uptake value (SUVmax) on 18F-FDG PET/CT was measured for all patients. Because nine patients showed low tumor-to-background uptake ratios, MTV and TLG were measured in 166 patients. Univariate and multivariate analyses were performed to evaluate the prognostic significance of SUVmax, MTV, TLG, and clinicopathological factors for disease progression-free survival.

Results

Disease progressed in 78 (44.6 %) of the 175 patients, and the 2-year disease progression-free survival rate was 57.5 %. Univariate analysis showed that tumor stage, histopathological type, presence of regional lymph node metastasis, residual tumor after cytoreductive surgery, pre-operative serum carbohydrate antigen 125 (CA125) level, SUVmax, MTV, and TLG were significant prognostic factors (p < 0.05). Among these variables, tumor stage (p = 0.0006) and TLG (p = 0.008) independently correlated with disease progression-free survival on multivariate analysis. The disease progression rate was only 2.3 % in stage I-II patients with low TLG (≤100.0), compared to 80.0 % in stage III-IV patients with high TLG (>100.0).

Conclusion

Along with tumor stage, TLG is an independent prognostic factor for disease progression after cytoreductive surgery in patients with epithelial ovarian cancer. By combining tumor stage and TLG, one can further stratify the risk of disease progression for patients undergoing cytoreductive surgery.
Literature
1.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.PubMedCrossRef
2.
Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, et al. Carcinoma of the ovary. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S161–92.PubMedCrossRef
3.
Tingulstad S, Skjeldestad FE, Halvorsen TB, Hagen B. Survival and prognostic factors in patients with ovarian cancer. Obstet Gynecol. 2003;101:885–91.PubMedCrossRef
4.
Bachmann C, Bachmann S, Fehm T, Staebler A, Becker S, Rothmund R, et al. Nodal status–its impact on prognosis in advanced ovarian cancer. J Cancer Res Clin Oncol. 2012;138:261–7.PubMedCrossRef
5.
Brun JL, Feyler A, Chene G, Saurel J, Brun G, Hocke C. Long-term results and prognostic factors in patients with epithelial ovarian cancer. Gynecol Oncol. 2000;78:21–7.PubMedCrossRef
6.
Makar AP, Baekelandt M, Trope CG, Kristensen GB. The prognostic significance of residual disease, FIGO substage, tumor histology, and grade in patients with FIGO stage III ovarian cancer. Gynecol Oncol. 1995;56:175–80.PubMedCrossRef
7.
Mury D, Woelber L, Jung S, Eulenburg C, Choschzick M, Witzel I, et al. Prognostic and predictive relevance of CA-125 at primary surgery of ovarian cancer. J Cancer Res Clin Oncol. 2011;137:1131–7.PubMedCrossRef
8.
Winter 3rd WE, Maxwell GL, Tian C, Carlson JW, Ozols RF, Rose PG, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:3621–7.PubMedCrossRef
9.
Winter 3rd WE, Maxwell GL, Tian C, Sundborg MJ, Rose GS, Rose PG, et al. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2008;26:83–9.PubMedCrossRef
10.
Hynninen J, Kemppainen J, Lavonius M, Virtanen J, Matomaki J, Oksa S, et al. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol. 2013;131:389–94.PubMedCrossRef
11.
Kim C, Chung HH, Oh SW, Kang KW, Chung JK, Lee DS. Differential diagnosis of borderline ovarian tumors from stage I malignant ovarian tumors using FDG PET/CT. Nucl Med Mol Imaging. 2013;47:81–8.PubMedCentralPubMedCrossRef
12.
Kitajima K, Suzuki K, Senda M, Kita M, Nakamoto Y, Onishi Y, et al. FDG-PET/CT for diagnosis of primary ovarian cancer. Nucl Med Commun. 2011;32:549–53.PubMedCrossRef
13.
Kitajima K, Ueno Y, Suzuki K, Kita M, Ebina Y, Yamada H, et al. Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT scans for diagnosing ovarian cancer recurrence. Eur J Radiol. 2012;81:3557–62.PubMedCrossRef
14.
Martoni AA, Fanti S, Zamagni C, Rosati M, De Iaco P. D’Errico Grigioni A, et al. [18 F] FDG-PET/CT monitoring early identifies advanced ovarian cancer patients who will benefit from prolonged neo-adjuvant chemotherapy. Q J Nucl Med Mol Imaging. 2011;55:81–90.PubMed
15.
Risum S, Loft A, Engelholm SA, Hogdall E, Berthelsen AK, Nedergaard L, et al. Positron emission tomography/computed tomography predictors of overall survival in stage IIIC/IV ovarian cancer. Int J Gynecol Cancer. 2012;22:1163–9.PubMedCrossRef
16.
Risum S, Hogdall C, Loft A, Berthelsen AK, Hogdall E, Nedergaard L, et al. Does the use of diagnostic PET/CT cause stage migration in patients with primary advanced ovarian cancer? Gynecol Oncol. 2010;116:395–8.PubMedCrossRef
17.
Nakamura K, Hongo A, Kodama J, Hiramatsu Y. The pretreatment of maximum standardized uptake values (SUVmax) of the primary tumor is predictor for poor prognosis for patients with epithelial ovarian cancer. Acta Med Okayama. 2012;66:53–60.PubMed
18.
Kurosaki H, Oriuchi N, Okazaki A, Tamaki T, Uki A, Izuta M, et al. Prognostic value of FDG-PET in patients with ovarian carcinoma following surgical treatment. Ann Nucl Med. 2006;20:171–4.PubMedCrossRef
19.
Hyun SH, Ahn HK, Kim H, Ahn MJ, Park K, Ahn YC, et al. Volume-based assessment by F-FDG PET/CT predicts survival in patients with stage III non-small-cell lung cancer. Eur J Nucl Med Mol Imaging. 2014;41:50–8.PubMedCrossRef
20.
Oh JR, Seo JH, Chong A, Min JJ, Song HC, Kim YC, et al. Whole-body metabolic tumour volume of 18 F-FDG PET/CT improves the prediction of prognosis in small cell lung cancer. Eur J Nucl Med Mol Imaging. 2012;39:925–35.PubMedCrossRef
21.
Ryu IS, Kim JS, Roh JL, Lee JH, Cho KJ, Choi SH, et al. Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis measured by 18 F-FDG PET/CT in salivary gland carcinomas. J Nucl Med. 2013;54:1032–8.PubMedCrossRef
22.
Yoo J, Choi JY, Moon SH, Bae DS, Park SB, Choe YS, et al. Prognostic significance of volume-based metabolic parameters in uterine cervical cancer determined using 18 F-fluorodeoxyglucose positron emission tomography. Int J Gynecol Cancer. 2012;22:1226–33.PubMedCrossRef
23.
Chung HH, Kwon HW, Kang KW, Park NH, Song YS, Chung JK, et al. Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis in patients with epithelial ovarian cancer. Ann Surg Oncol. 2012;19:1966–72.PubMedCrossRef
24.
Liao S, Lan X, Cao G, Yuan H, Zhang Y. Prognostic Predictive Value of Total Lesion Glycolysis From 18 F-FDG PET/CT in Post-Surgical Patients With Epithelial Ovarian Cancer. Clin Nucl Med. 2013;38:715–20.PubMedCrossRef
25.
Fonti R, Larobina M, Del Vecchio S, De Luca S, Fabbricini R, Catalano L, et al. Metabolic tumor volume assessed by 18 F-FDG PET/CT for the prediction of outcome in patients with multiple myeloma. J Nucl Med. 2012;53:1829–35.PubMedCrossRef
26.
Uto F, Shiba E, Onoue S, Yoshimura H, Takada M, Tsuji Y, et al. Phantom study on radiotherapy planning using PET/CT–delineation of GTV by evaluating SUV. J Radiat Res. 2010;51:157–64.PubMedCrossRef
27.
Lim R, Eaton A, Lee NY, Setton J, Ohri N, Rao S, et al. 18 F-FDG PET/CT metabolic tumor volume and total lesion glycolysis predict outcome in oropharyngeal squamous cell carcinoma. J Nucl Med. 2012;53:1506–13.PubMedCrossRef
28.
Kitajima K, Murakami K, Yamasaki E, Kaji Y, Fukasawa I, Inaba N, et al. Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT. Eur J Nucl Med Mol Imaging. 2008;35:1912–20.PubMedCrossRef
29.
Castellucci P, Perrone AM, Picchio M, Ghi T, Farsad M, Nanni C, et al. Diagnostic accuracy of 18 F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology. Nucl Med Commun. 2007;28:589–95.PubMedCrossRef
30.
Sanli Y, Turkmen C, Bakir B, Iyibozkurt C, Ozel S, Has D, et al. Diagnostic value of PET/CT is similar to that of conventional MRI and even better for detecting small peritoneal implants in patients with recurrent ovarian cancer. Nucl Med Commun. 2012;33:509–15.PubMedCrossRef
31.
du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115:1234–44.PubMedCrossRef
32.
Zhang H, Wroblewski K, Liao S, Kampalath R, Penney BC, Zhang Y, et al. Prognostic value of metabolic tumor burden from (18) F-FDG PET in surgical patients with non-small-cell lung cancer. Acad Radiol. 2013;20:32–40.PubMedCrossRef
33.
Yoon HJ, Paeng JC, Kwak C, Park YH, Kim TM, Lee SH, et al. Prognostic implication of extrarenal metabolic tumor burden in advanced renal cell carcinoma treated with targeted therapy after nephrectomy. Ann Nucl Med. 2013;27:748–55.PubMedCrossRef
34.
Lee SJ, Choi JY, Lee HJ, Baek CH, Son YI, Hyun SH, et al. Prognostic value of volume-based (18) F-fluorodeoxyglucose PET/CT parameters in patients with clinically node-negative oral tongue squamous cell carcinoma. Korean J Radiol. 2012;13:752–9.PubMedCentralPubMedCrossRef
35.
Hyun SH, Choi JY, Kim K, Kim J, Shim YM, Um SW, et al. Volume-based parameters of (18) F-fluorodeoxyglucose positron emission tomography/computed tomography improve outcome prediction in early-stage non-small cell lung cancer after surgical resection. Ann Surg. 2013;257:364–70.PubMedCrossRef
36.
Prat J. Ovarian carcinomas: five distinct diseases with different origins, genetic alterations, and clinicopathological features. Virchows Arch. 2012;460:237–49.PubMedCrossRef
Metadata
Title
The role of metabolic tumor volume and total lesion glycolysis on 18F-FDG PET/CT in the prognosis of epithelial ovarian cancer
Authors
Jeong Won Lee
Arthur Cho
Jae-Hoon Lee
Mijin Yun
Jong Doo Lee
Young Tae Kim
Won Jun Kang
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2803-x

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