title: Preoperative fluorine 18 fluorodeoxyglucose tumoral uptake ratio between upper and lower abdomen in primary advanced-stage ovarian cancer.
abstract: OBJECTIVE
  The objective of this study was to assess whether the ratio of upper abdomen (UA) to lower abdomen (LA) (relative to the umbilicus) standardized fluorine 18 fluorodeoxyglucose uptake, as measured by preoperative positron emission tomography and computed tomography, is predictive of recurrence, survival, and suboptimal cytoreduction (residual tumor >1.0 cm) in advanced-stage ovarian cancer (AOC).
  
  
  METHODS
  Positron emission tomography/computed tomography before surgical staging was performed in 159 AOC patients. The ratio between the highest maximum standardized uptake value (SUV(max)) in the UA and the LA was expressed as UA/LA SUV(max). Clinicopathological characteristics and follow-up information were collected retrospectively. Cox proportional hazards analysis was used to identify prognostic factors for recurrence and survival. Logistic regression analysis was used to identify predictors of suboptimal cytoreduction.
  
  
  RESULTS
  The median age and follow-up period were 55 years (range, 27-80 years) and 32 months (range, 1-92 months), respectively; 133 and 26 patients had stage III and IV disease, respectively. There were 120 and 54 cases of recurrence and disease-specific death, respectively. Multivariate analysis showed that recurrence was associated significantly with high UA/LA SUV(max) (P < 0.05; hazard ratio [HR], 4.902; 95% confidence interval [CI], 2.521-9.531) and suboptimal cytoreduction (P < 0.05; HR, 2.431; 95% CI, 1.561-3.788), and that disease-specific death was significantly associated with high UA/LA SUV(max) (P < 0.05; HR, 2.777; 95% CI, 1.270-6.075), suboptimal cytoreduction (P < 0.05; HR, 1.951; 95% CI, 1.080-3.524), and histology (P < 0.05; HR, 4.134; 95% CI, 1.676-10.196). Upper abdomen/lower abdomen SUV(max) was the only independent predictor of suboptimal cytoreduction (P < 0.05; odds ratio, 4.644; 95% CI, 1.676-12.862).
  
  
  CONCLUSIONS
  High preoperative UA/LA SUV(max) was significantly associated with poor prognosis and may be predictive of suboptimal cytoreduction in AOC. This parameter may be considered in the treatment of AOC patients.
authors.affiliation: *Department of Obstetrics and Gynecology, School of Medicine, Konkuk University; and Departments of †Obstetrics and Gynecology and ‡Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Shim
authors.forename: Dae-Yeon
authors.initials: DY
authors.lastname: Kim
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Seo
authors.forename: Shin-Wha
authors.initials: SW
authors.lastname: Lee
authors.forename: Jeong-Yeol
authors.initials: JY
authors.lastname: Park
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Lee
authors.forename: Jong-Hyeok
authors.initials: JH
authors.lastname: Kim
authors.forename: Yong-Man
authors.initials: YM
authors.lastname: Kim
authors.forename: Young-Tak
authors.initials: YT
authors.lastname: Kim
authors.forename: Joo-Hyun
authors.initials: JH
authors.lastname: Nam
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18