Skip to main content

Prognostic value of volume-based metabolic parameters of 18F-FDG PET/CT in ovarian cancer: a systematic review and meta-analysis

Annals of Nuclear Medicine volume 32, pages 669–677 (2018)Cite this article

Abstract

Objective

To perform a systematic review and meta-analysis on the prognostic value of 18F-FDG PET-derived volume-based parameters regarding metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with ovarian cancer.

Methods

Pubmed and EMBASE databases were searched up to February 12, 2018 for studies which evaluated MTV or TLG as a prognostic factor in ovarian cancer with progression-free (PFS) and overall survival (OS) as the endpoints. Hazard ratios (HRs) were meta-analytically pooled using the random-effects model. Multiple subgroup analyses based on clinicopathological and PET variables were performed.

Results

Eight studies with 473 patients were included. The pooled HRs of MTV and TLG for PFS were 2.50 (95% CI 1.79–3.48; p < 0.00001) and 2.42 (95% CI 1.61–3.65; p < 0.0001), respectively. Regarding OS, the pooled HRs of MTV and TLG were 8.06 (95% CI 4.32–15.05; p < 0.00001) and 7.23 (95% CI 3.38–15.50; p < 0.00001), respectively. Multiple subgroup analyses consistently showed that MTV and TLG were significant prognostic factors for PFS with pooled HRs ranging from 2.35 to 2.58 and from 1.73 to 3.35, respectively.

Conclusions

MTV and TLG from 18F-FDG PET were significant prognostic factors in patients with ovarian cancer. Despite the clinical heterogeneity and difference in methodology between the studies, patients with a high MTV or TLG have a higher risk of disease progression or death.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2017;67:7–30.

    Article  Google Scholar 

  2. Khiewvan B, Torigian DA, Emamzadehfard S, Paydary K, Salavati A, Houshmand S, et al. An update on the role of PET/CT and PET/MRI in ovarian cancer. Eur J Nucl Med Mol Imaging. 2017;44:1079–91.

    CAS  Article  Google Scholar 

  3. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz F. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. Eisenhauer EA, Vermorken JB, van Glabbeke M. Predictors of response to subsequent chemotherapy in platinum pretreated ovarian cancer: a multivariate analysis of 704 patients. Ann Oncol. 1997;8:963–8.

    CAS  Article  Google Scholar 

  6. Eltabbakh GH, Mount SL, Beatty B, Simmons-Arnold L, Cooper K, Morgan A. Factors associated with cytoreducibility among women with ovarian carcinoma. Gynecol Oncol. 2004;95:377–83.

    CAS  Article  Google Scholar 

  7. Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. The standardized uptake value for F-18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival. Cancer. 2007;110:1738–44.

    Article  Google Scholar 

  8. Moon SH, Hyun SH, Choi JY. Prognostic significance of volume-based PET parameters in cancer patients. Korean J Radiol. 2013;14:1–12.

    Article  Google Scholar 

  9. Im HJ, Pak K, Cheon GJ, Kang KW, Kim SJ, Kim IJ, et al. Prognostic value of volumetric parameters of (18)F-FDG PET in non-small-cell lung cancer: a meta-analysis. Eur J Nucl Med Mol Imaging. 2015;42:241–51.

    CAS  Article  Google Scholar 

  10. Pak K, Cheon GJ, Nam HY, Kim SJ, Kang KW, Chung JK, et al. Prognostic value of metabolic tumor volume and total lesion glycolysis in head and neck cancer: a systematic review and meta-analysis. J Nucl Med. 2014;55:884–90.

    CAS  Article  Google Scholar 

  11. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–34.

    Article  Google Scholar 

  12. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med. 1998;17:2815–34.

    CAS  Article  Google Scholar 

  13. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.

    Article  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  15. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    CAS  Article  Google Scholar 

  16. Ciftci E, Turgut B, Cakmakcilar A, Erturk SA. Diagnostic importance of 18F-FDG PET/CT parameters and total lesion glycolysis in differentiating between benign and malignant adrenal lesions. Nucl Med Commun. 2017;38:788–94.

    CAS  Article  Google Scholar 

  17. Park T, Lee S, Park S, Lee E, Pahk K, Rhee S, et al. Value of 18 F-FDG PET/CT in the Detection of Ovarian Malignancy. Nucl Med Mol Imaging. 2015;49:42–51.

    CAS  Article  Google Scholar 

  18. Lee M, Lee H, Cheon GJ, Kim HS, Chung HH, Kim J-W, et al. Prognostic value of preoperative intratumoral FDG uptake heterogeneity in patients with epithelial ovarian cancer. Eur Radiol. 2017;27:16–23.

    Article  Google Scholar 

  19. Takeuchi S, Lucchini M, Schmeler KM, Coleman RL, Gershenson DM, Munsell MF, et al. Utility of 18F-FDG PET/CT in follow-up of patients with low-grade serous carcinoma of the ovary. Gynecol Oncol. 2014;133:100–4.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. Gallicchio R, Nardelli A, Venetucci A, Capacchione D, Pelagalli A, Sirignano C, et al. F-18 FDG PET/CT metabolic tumor volume predicts overall survival in patients with disseminated epithelial ovarian cancer. Eur J Radiol. 2017;93:107–13.

    Article  Google Scholar 

  22. Kim CY, Jeong SY, Chong GO, Son SH, Jung JH, Kim DH, et al. Quantitative metabolic parameters measured on F-18 FDG PET/CT predict survival after relapse in patients with relapsed epithelial ovarian cancer. Gynecol Oncol. 2015;136:498–504.

    Article  Google Scholar 

  23. Lee JW, Cho A, Lee JH, Yun M, Lee JD, Kim YT, et al. The role of metabolic tumor volume and total lesion glycolysis on (1)(8)F-FDG PET/CT in the prognosis of epithelial ovarian cancer. Eur J Nucl Med Mol Imaging. 2014;41:1898–906.

    Article  Google Scholar 

  24. Liao S, Lan X, Cao G, Yuan H, Zhang Y. Prognostic predictive value of total lesion glycolysis from 18F-FDG PET/CT in post-surgical patients with epithelial ovarian cancer. Clin Nucl Med. 2013;38:715–20.

    Article  Google Scholar 

  25. Mayoral M, Fernandez-Martinez A, Vidal L, Fuster D, Aya F, Pavia J, et al. Prognostic value of 18 F-FDG PET/CT volumetric parameters in recurrent epithelial ovarian cancer. Revista Española de Medicina Nuclear e Imagen Molecular (English Edition). 2016;35:88–95.

    CAS  Article  Google Scholar 

  26. Vargas HA, Burger IA, Goldman DA, Micco M, Sosa RE, Weber W, et al. Volume-based quantitative FDG PET/CT metrics and their association with optimal debulking and progression-free survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery. Eur Radiol. 2015;25:3348–53.

    CAS  Article  Google Scholar 

  27. Yamamoto M, Tsujikawa T, Fujita Y, Chino Y, Kurokawa T, Kiyono Y, et al. Metabolic tumor burden predicts prognosis of ovarian cancer patients who receive platinum-based adjuvant chemotherapy. Cancer Sci. 2016;107:478–85.

    CAS  Article  Google Scholar 

  28. Vallius T, Hynninen J, Kemppainen J, Alves V, Auranen K, Matomaki J, et al. (18)F-FDG-PET/CT based total metabolic tumor volume change during neoadjuvant chemotherapy predicts outcome in advanced epithelial ovarian cancer. Eur J Nucl Med Mol Imaging. 2018;45:1224–32.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Meta-analysis for Imaging studies on Diagnostic test Accuracy and prognosiS (MIDAS) group, Seoul, Republic of Korea

    Sangwon Han, Chong Hyun Suh & Sungmin Woo

  2. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Sangwon Han

  3. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hyesung Kim

  4. Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon, South Korea

    Yeon Joo Kim

  5. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Chong Hyun Suh

  6. Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Sungmin Woo

Authors
  1. Sangwon Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyesung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yeon Joo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chong Hyun Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sungmin Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sungmin Woo.

Ethics declarations

Conflict of interest

The authors have nothing to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Han, S., Kim, H., Kim, Y.J. et al. Prognostic value of volume-based metabolic parameters of 18F-FDG PET/CT in ovarian cancer: a systematic review and meta-analysis. Ann Nucl Med 32, 669–677 (2018). https://doi.org/10.1007/s12149-018-1289-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-018-1289-1

Keywords

  • PET
  • Ovarian cancer
  • Metabolic tumor volume
  • Total lesion glycolysis
  • Prognosis