title: Preoperative [F]FDG PET/CT predicts recurrence in patients with epithelial ovarian cancer.
abstract: OBJECTIVE
  To determine whether [(18)F]FDG uptake on PET/CT imaging before surgical staging has prognostic significance in patients with epithelial ovarian cancer (EOC).
  
  
  METHODS
  Patients with EOC were imaged with integrated PET/CT before surgical staging. Hypermetabolic lesions were measured as the standardized uptake value (SUV) in primary and metastatic tumors. SUV distribution was divided into two regions at the level of umbilicus, and the impact of the ratio between above and below umbilicus (SUV(location) ratio) on progression-free survival (PFS) was examined using Cox proportional hazards regression.
  
  
  RESULTS
  Between January 2004 and December 2009, 55 patients with EOC underwent preoperative PET/CT. The median duration of PFS was 11 months (range, 3 to 43 months), and twenty (36.4%) patients experienced recurrence. In univariate analysis, high SUV(location) ratio (p=0.002; hazard ratio [HR], 1.974; 95% confidence interval [CI], 1.286 to 3.031) was significantly associated with recurrence. Malignant mixed mullerian tumor compared with endometrioid histology was also shown to have significance. In multivariate analysis, high SUV(location) ratio (p=0.005; HR, 2.418; 95% CI, 1.1315 to 4.447) and histology (serous, mucinous, and malignant mixed mullerian tumor compared with endometrioid type) were significantly associated with recurrence. Patients were categorized into two groups according to SUV(location) ratio (<0.3934 vs. ≥0.3934), and the Kaplan-Meier survival graph showed a significant difference in PFS between the groups (p=0.0021; HR, 9.47, log-rank test).
  
  
  CONCLUSIONS
  SUV distribution showed a significant association with recurrence in patients with EOC, and may be a useful predictor of recurrence.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyun Hoon
authors.initials: HH
authors.lastname: Chung
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Kwon
authors.forename: Keon Wook
authors.initials: KW
authors.lastname: Kang
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
authors.forename: Noh-Hyun
authors.initials: NH
authors.lastname: Park
authors.forename: Yong-Sang
authors.initials: YS
authors.lastname: Song
authors.forename: Soon-Beom
authors.initials: SB
authors.lastname: Kang