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Prognostic Value of Preoperative Metabolic Tumor Volume and Total Lesion Glycolysis in Patients with Epithelial Ovarian Cancer

Annals of Surgical Oncology volume 19, pages 1966–1972 (2012)Cite this article

Abstract

Purpose

Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are measures of metabolic activity of tumors determined by fluorine-18 fluorodeoxyglucose ([18F]FDG) uptake on PET/CT images. The purpose of this study was to investigate the relationship between functional tumor parameters (MTV and TLG) and clinical outcomes in patients with epithelial ovarian cancer (EOC).

Methods

Fifty-five patients with EOC who had undergone [18F]FDG PET/CT before surgical staging were included in this retrospectively study. For each patient, we determined the highest (SUVmax and SUVavg), the cumulative TLG, and the sum of all MTV, and compared their predictive value of recurrence and the effects of pretreatment functional tumor activity on progression-free interval (PFI).

Results

The median duration of PFI was 11 (range 3–43) months, and 20 patients (36.4%) experienced recurrence. Poor outcome was associated with higher values for both the MTV (P = 0.022, hazard ratio 5.571, 95% confidence interval 1.279–24.272) and the TLG (P = 0.037, hazard ratio 2.967, 95% confidence interval 1.065–8.265). The Kaplan–Meier survival graphs showed a significant difference in PFI between the groups categorized by MTV and TLG, respectively (P = 0.01 for MTV, P = 0.0287 for TLG, log rank test).

Conclusions

Pretreatment metabolic parameters such as MTV and TLG showed statistically significant association with recurrence in patients with EOC. These values can be useful quantitative criteria for disease prognostication in patients with EOC before treatment.

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References

  1. Bristow RE, Duska LR, Lambrou NC, Fishman EK, O’Neill MJ, Trimble EL, et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer. 2000;89:1532–40.

    PubMed  Article  CAS  Google Scholar 

  2. Park B, Park S, Kim TJ, Ma SH, Kim BG, Kim YM, et al. Epidemiological characteristics of ovarian cancer in Korea. J Gynecol Oncol. 2010;21:241–7.

    PubMed  Article  Google Scholar 

  3. Forstner R, Chen M, Hricak H. Imaging of ovarian cancer. J Magn Reson Imaging. 1995;5:606–13.

    PubMed  Article  CAS  Google Scholar 

  4. Kim MK, Kim K, Kim SM, Kim JW, Park NH, Song YS, et al. A hospital-based case-control study of identifying ovarian cancer using symptom index. J Gynecol Oncol. 2009;20:238–42.

    PubMed  Article  Google Scholar 

  5. Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007;109:221–7.

    PubMed  Article  Google Scholar 

  6. Amendola MA. The role of CT in the evaluation of ovarian malignancy. Crit Rev Diagn Imaging. 1985;24:329–68.

    PubMed  CAS  Google Scholar 

  7. Prakash P, Cronin CG, Blake MA. Role of PET/CT in ovarian cancer. AJR Am J Roentgenol. 2010;194:W464–70.

    PubMed  Article  Google Scholar 

  8. Chung HH, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, et al. Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings. Eur J Nucl Med Mol Imaging. 2007;34:480–6.

    PubMed  Article  Google Scholar 

  9. 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.

    PubMed  Article  Google Scholar 

  10. Dirisamer A, Schima W, Heinisch M, Weber M, Lehner HP, Haller J, et al. Detection of histologically proven peritoneal carcinomatosis with fused 18F-FDG-PET/MDCT. Eur J Radiol. 2009;69:536–41.

    PubMed  Article  Google Scholar 

  11. Erdi YE, Macapinlac H, Rosenzweig KE, Humm JL, Larson SM, Erdi AK, et al. Use of PET to monitor the response of lung cancer to radiation treatment. Eur J Nucl Med. 2000;27:861–6.

    PubMed  Article  CAS  Google Scholar 

  12. Kitajima K, Murakami K, Yamasaki E, Domeki Y, Kaji Y, Fukasawa I, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging. 2008;35:1439–48.

    PubMed  Article  Google Scholar 

  13. Bhosale P, Peungjesada S, Wei W, Levenback CF, Schmeler K, Rohren E, et al. Clinical utility of positron emission tomography/computed tomography in the evaluation of suspected recurrent ovarian cancer in the setting of normal CA-125 levels. Int J Gynecol Cancer. 2010;20:936–44.

    PubMed  Article  Google Scholar 

  14. Risum S, Loft A, Hogdall C, Berthelsen AK, Hogdall E, Lundvall L, et al. Standardized FDG uptake as a prognostic variable and as a predictor of incomplete cytoreduction in primary advanced ovarian cancer. Acta Oncol. 2011;50:415–9.

    PubMed  Article  Google Scholar 

  15. 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.

    PubMed  Article  CAS  Google Scholar 

  16. Francis RJ, Byrne MJ, van der Schaaf AA, Boucek JA, Nowak AK, Phillips M, et al. Early prediction of response to chemotherapy and survival in malignant pleural mesothelioma using a novel semiautomated 3-dimensional volume-based analysis of serial 18F-FDG PET scans. J Nucl Med. 2007;48:1449–58.

    PubMed  Article  Google Scholar 

  17. Veit-Haibach P, Schaefer NG, Steinert HC, Soyka JD, Seifert B, Stahel RA. Combined FDG-PET/CT in response evaluation of malignant pleural mesothelioma. Lung Cancer. 2010;67:311–7.

    PubMed  Article  Google Scholar 

  18. Metz CE. Basic principles of ROC analysis. Semin Nucl Med. 1978;8:283–98.

    PubMed  Article  CAS  Google Scholar 

  19. Roedl JB, Colen RR, Holalkere NS, Fischman AJ, Choi NC, Blake MA. Adenocarcinomas of the esophagus: response to chemoradiotherapy is associated with decrease of metabolic tumor volume as measured on PET-CT. Comparison to histopathologic and clinical response evaluation. Radiother Oncol. 2008;89:278–86.

    PubMed  Article  CAS  Google Scholar 

  20. Chung MK, Jeong HS, Park SG, Jang JY, Son YI, Choi JY, et al. Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res. 2009;15:5861–8.

    PubMed  Article  CAS  Google Scholar 

  21. La TH, Filion EJ, Turnbull BB, Chu JN, Lee P, Nguyen K, et al. Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;74:1335–41.

    PubMed  Article  Google Scholar 

  22. Moeller BJ, Rana V, Cannon BA, Williams MD, Sturgis EM, Ginsberg LE, et al. Prospective risk-adjusted [18F]Fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. J Clin Oncol. 2009;27:2509–15.

    PubMed  Article  Google Scholar 

  23. Um SW, Kim H, Koh WJ, Suh GY, Chung MP, Kwon OJ, et al. Prognostic value of 18F-FDG uptake on positron emission tomography in patients with pathologic stage I non-small cell lung cancer. J Thorac Oncol. 2009;4:1331–6.

    PubMed  Article  Google Scholar 

  24. Steinert HC, Santos Dellea MM, Burger C, Stahel R. Therapy response evaluation in malignant pleural mesothelioma with integrated PET-CT imaging. Lung Cancer. 2005;49(Suppl 1):S33–5.

    PubMed  Article  Google Scholar 

  25. Guillem JG, Moore HG, Akhurst T, Klimstra DS, Ruo L, Mazumdar M, et al. Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer. J Am Coll Surg. 2004;199:1–7.

    PubMed  Article  Google Scholar 

  26. Tateishi U, Gamez C, Dawood S, Yeung HW, Cristofanilli M, Macapinlac HA. Bone metastases in patients with metastatic breast cancer: morphologic and metabolic monitoring of response to systemic therapy with integrated PET/CT. Radiology. 2008;247:189–96.

    PubMed  Article  Google Scholar 

  27. Chung HH, Kim JW, Han KH, Eo JS, Kang KW, Park NH, et al. Prognostic value of metabolic tumor volume measured by FDG-PET/CT in patients with cervical cancer. Gynecol Oncol. 2011;120:270–4.

    PubMed  Article  Google Scholar 

  28. Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.

    PubMed  Google Scholar 

  29. Keyes JW Jr. SUV: standard uptake or silly useless value? J Nucl Med. 1995;36:1836–9.

    PubMed  Google Scholar 

  30. Westerterp M, Pruim J, Oyen W, Hoekstra O, Paans A, Visser E, et al. Quantification of FDG PET studies using standardised uptake values in multi-centre trials: effects of image reconstruction, resolution and ROI definition parameters. Eur J Nucl Med Mol Imaging. 2007;34:392–404.

    PubMed  Article  Google Scholar 

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Disclosure

The authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hyun Hoon Chung MD, PhD, Noh-Hyun Park MD, PhD, Yong-Sang Song MD, PhD, Soon-Beom Kang MD, PhD & Jae Weon Kim MD, PhD

  2. Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hyun Woo Kwon MD, Keon Wook Kang MD, PhD & June-Key Chung MD, PhD

  3. WCU Biomodulation Major, Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea

    Yong-Sang Song MD, PhD

Authors
  1. Hyun Hoon Chung MD, PhD
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  2. Hyun Woo Kwon MD
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  4. Noh-Hyun Park MD, PhD
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  6. June-Key Chung MD, PhD
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  7. Soon-Beom Kang MD, PhD
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  8. Jae Weon Kim MD, PhD
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Correspondence to Jae Weon Kim MD, PhD.

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Chung, H.H., Kwon, H.W., Kang, K.W. et al. Prognostic Value of Preoperative Metabolic Tumor Volume and Total Lesion Glycolysis in Patients with Epithelial Ovarian Cancer. Ann Surg Oncol 19, 1966–1972 (2012). https://doi.org/10.1245/s10434-011-2153-x

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  • DOI: https://doi.org/10.1245/s10434-011-2153-x

Keywords

  • Standardize Uptake Value
  • Epithelial Ovarian Cancer
  • Cytoreductive Surgery
  • Metabolic Tumor Volume
  • Mucinous Adenocarcinoma