title: Prognostic predictive value of total lesion glycolysis from 18F-FDG PET/CT in post-surgical patients with epithelial ovarian cancer.
abstract: OBJECTIVE
  The aim of this study was to determine an optimal threshold method for the segmentation of malignant lesions from (18)F-FDG PET/CT images and to evaluate the prognostic value of the total lesion glycolysis in post-surgical patients with epithelial ovarian cancer.
  
  
  METHODS
  We retrospectively reviewed 47 patients with pathologically proven epithelial ovarian cancer who underwent (18)F-FDG PET/CT imaging after surgery. The follow-up time was 26.6 ± 19.8 months (ranged from 4 to 89 months). For each patient, every lesion was segmented by 2 thresholds with 3D-area growing algorithm, standard uptake value (SUV) 2.5, and background method. The detection rates were compared. The optimal threshold method was then used to calculate whole-body metabolic tumor volume (WBMTV) and whole-body total lesion glycolysis (WBTLG). The prognostic significance of SUV(max), WBMTV, WBTLG, and other pathological variables for overall survival were assessed by Cox proportional hazards regression analysis and Kaplan-Meier survival analysis.
  
  
  RESULTS
  A total of 142 metastatic lesions of 47 patients were confirmed by long-term clinical follow-up or pathological findings. The detection rates of the threshold SUV 2.5 and background methods were 37.32% (53/142) and 96.48% (137/142), respectively, which showed significant difference between the 2 methods (P < 0.005). In multivariate analysis, WBTLG, obtained from the background method, was an independent predictive factor associated with the prognosis (HR 1.043, 95% CI 1.01-1.078, P = 0.011), and none of the other factors had statistical association. Survival analysis also showed that the survival time was clearly shortened with WBTLG increasing (P < 0.001).
  
  
  CONCLUSIONS
  In this group of post-surgery patients with epithelial ovarian cancer, the background method could segment much more malignant lesions than SUV = 2.5 method, and WBTLG, obtained from this method, could be used as an independent prognostic factor.
authors.affiliation: Department of Nuclear Medicine, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
authors.forename: Shanshan
authors.initials: S
authors.lastname: Liao
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Lan
authors.forename: Guoxiang
authors.initials: G
authors.lastname: Cao
authors.forename: Hui
authors.initials: H
authors.lastname: Yuan
authors.forename: Yongxue
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008875:Middle Aged; D064847:Multimodal Imaging; D009375:Neoplasms, Glandular and Epithelial / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000601:surgery; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18