title: Prognostic significance of mediastinal 18F-FDG uptake in PET/CT in advanced ovarian cancer.
abstract: OBJECTIVE
  To evaluate the prognostic significance of increased mediastinal (18)F-FDG uptake in PET/CT for the staging of advanced ovarian cancer.
  
  
  METHODS
  We retrospectively evaluated patients managed for FIGO stage III/IV ovarian cancer between 1 January 2006 and 1 June 2009. Patients were included if they had undergone (18)F-FDG PET/CT and surgery for initial staging. Exclusion criteria were age younger than 18 years, inability to undergo general anaesthesia, recurrent ovarian cancer, and borderline or nonepithelial malignancy. Whole-body PET/CT was performed after intravenous (18)F-FDG injection. The location of abnormal hot spots and (18)F-FDG maximal standard uptake values (SUV(max)) were recorded. We compared the complete cytoreduction and survival rates in groups defined based on mediastinal (18)F-FDG uptake and SUV(max) values. Kaplan-Meier curves of overall survival and disease-free survival were compared using the log-rank test. Hazard ratios with their 95% confidence intervals were computed. Adjusted hazard ratios were obtained using a multivariate Cox model.
  
  
  RESULTS
  We included 53 patients, of whom 17 (32%) had increased mediastinal (18)F-FDG uptake. Complete cytoreduction was achieved in 14 (87.5%) of the 16 patients managed with primary surgery and in 21 (75%) of the 28 patients managed with interval surgery. Complete cytoreduction was achieved significantly more often among patients without increased mediastinal (18)F-FDG uptake (80.6% vs. 35.3%; p = 0.001). Disease-free survival was comparable between the two groups. By univariate analysis, overall mortality was significantly higher among patients with increased mediastinal (18)F-FDG uptake (hazard ratio 5.70, 95% confidence interval 1.74-18.6). The only factor significantly associated with overall survival by multivariate analysis was complete cytoreduction (adjusted hazard ratio 0.24, 95% confidence interval 0.07-0.89).
  
  
  CONCLUSIONS
  Increased mediastinal (18)F-FDG uptake was common in patients with advanced ovarian cancer. However, complete cytoreduction, which was significantly more frequent among patients without mediastinal (18)F-FDG uptake, was the only factor independently associated with survival.
authors: Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. anne-sophie.bats@egp.aphp.fr
authors: Anne-Sophie
authors: AS
authors: Bats
authors: Florent
authors: F
authors: Hugonnet
authors: Cyrille
authors: C
authors: Huchon
authors: Chérazade
authors: C
authors: Bensaid
authors: Nadia
authors: N
authors: Pierquet-Ghazzar
authors: Marc
authors: M
authors: Faraggi
authors: Fabrice
authors: F
authors: Lécuru
mesh_terms: D001692:Biological Transport; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D008482:Mediastinum; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18