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Predictive value of 18F-FDG PET/CT in restaging patients affected by ovarian carcinoma: a multicentre study

  • Federico Caobelli
  • Pierpaolo AlongiEmail author
  • Laura Evangelista
  • Maria Picchio
  • Giorgio Saladini
  • Marco Rensi
  • Onelio Geatti
  • Angelo Castello
  • Iashar Laghai
  • Cristina E. Popescu
  • Carlotta Dolci
  • Cinzia Crivellaro
  • Silvia Seghezzi
  • Margarita Kirienko
  • Vincenzo De Biasi
  • Fabrizio Cocciolillo
  • Natale Quartuccio
  • Young AIMN Working Group
Original Article

Abstract

Purpose

Ovarian cancer is the eighth most common malignancy among women and has a high mortality rate. Prognostic factors able to drive an effective therapy are essential. 18F-Fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been investigated in patients with epithelial ovarian cancer and showed promise in diagnosing, staging, detecting recurrent lesions and monitoring treatment response. Conversely, its prognostic role remains unclear. We aimed at assessing the prognostic value of 18F-FDG PET/CT performed in the restaging process in a multicentre study.

Methods

We evaluated 168 patients affected by ovarian carcinoma, who underwent a restaging 18F-FDG PET/CT. The presence of local recurrences, lymph node involvement and distant metastasis was recorded as well as lesion dimensions, maximum and mean standardized uptake values (SUVmax and SUVmean, respectively). Progression-free survival (PFS) and overall survival (OS) at 3 and 4 years were computed by using Kaplan-Meier curves. Increased odds ratio was assessed using Cox regression analysis testing all lesion parameters measured by PET/CT.

Results

PFS was significantly longer in patients with a negative than a positive restaging PET/CT study (3- and 4-year PFS 64 and 53 % vs 23 and 12 %, respectively; p < 0.001). Similarly, a negative study was associated with a significantly higher OS rate after 4 years of follow-up (67 vs 25 % in negative and positive groups, respectively; p < 0.001). Lymph node or distant involvement were also independently associated with an increased risk of disease progression [hazard ratio (HR) 1.6 and 2.2, respectively; p = 0.003]. Moreover, PET/CT showed an incremental prognostic value compared to the International Federation of Gynecology and Obstetrics (FIGO) staging system. In the analysis of patient subsets, individuals with the same FIGO stage I–II but with negative PET had a significantly better 4-year OS than patients with low FIGO stage but positive PET. This implies that patients with the same FIGO stage can be further prognostically stratified using PET (p = 0.01). At receiver-operating characteristic (ROC) analysis, no thresholds for semiquantitative parameters were predictive of a worse outcome.

Conclusion

18F-FDG PET/CT has an important prognostic value in assessing the risk of disease progression and mortality rate. An efficacious therapy planning might therefore effectively rely on 18F-FDG PET/CT findings. Semiquantitative data were not proven to be an effective tool to predict disease progression.

Keywords

Ovarian carcinoma 18F-FDG PET/CT Prognostic value FIGO staging system Restaging 

Notes

Acknowledgments

We would like to thank all the institutions and their co-workers who actively participated in our multicentre study for their invaluable help. We also thank Dr. James T. Thackeray for language editing and thorough revision of the manuscript.

Compliance with ethical standards

Conflicts of interest

None.

Financial support

The authors disclose that they did not receive any personal or financial support for this multicentre study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Federico Caobelli
    • 1
  • Pierpaolo Alongi
    • 2
    • 3
    Email author
  • Laura Evangelista
    • 4
  • Maria Picchio
    • 3
  • Giorgio Saladini
    • 4
  • Marco Rensi
    • 5
  • Onelio Geatti
    • 5
  • Angelo Castello
    • 6
  • Iashar Laghai
    • 6
  • Cristina E. Popescu
    • 7
  • Carlotta Dolci
    • 8
  • Cinzia Crivellaro
    • 8
  • Silvia Seghezzi
    • 9
  • Margarita Kirienko
    • 2
  • Vincenzo De Biasi
    • 10
  • Fabrizio Cocciolillo
    • 11
  • Natale Quartuccio
    • 12
  • Young AIMN Working Group
    • 13
  1. 1.Klinik für NuklearmedizinMedizinische Hochschule HannoverHanoverGermany
  2. 2.Nuclear Medicine UnitUniversity of Milano-BicoccaMilanItaly
  3. 3.Nuclear Medicine DepartmentIRCSS San Raffaele Scientific InstituteMilanItaly
  4. 4.Radiotherapy and Nuclear Medicine UnitVeneto Institute of Oncology IOV – IRCCSPaduaItaly
  5. 5.Nuclear Medicine DepartmentHospital of UdineUdineItaly
  6. 6.Nuclear Medicine DepartmentUniversity of FlorenceFlorenceItaly
  7. 7.Nuclear Medicine DepartmentNiguarda Ca’ Granda HospitalMilanItaly
  8. 8.Nuclear Medicine Department; San Gerardo Hospital, Tecnomed FoundationUniversity of Milan-BicoccaMilanItaly
  9. 9.Nuclear Medicine DepartmentHospital of TreviglioTreviglioItaly
  10. 10.Nuclear Medicine Department, Arcispedale Santa Maria NuovaReggio EmiliaItaly
  11. 11.Nuclear Medicine DepartmentCatholic University of the Sacred HeartRomeItaly
  12. 12.Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphological and Functional ImagesUniversity of MessinaMessinaItaly
  13. 13.Executive Committee of the Italian Association of Nuclear Medicine – Youth SectionMilanItaly

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