title: Predictive value of (18)F-FDG PET/CT in restaging patients affected by ovarian carcinoma: a multicentre study.
abstract: OBJECTIVE
  Ovarian cancer is the eighth most common malignancy among women and has a high mortality rate. Prognostic factors able to drive an effective therapy are essential. (18)F-Fluoro-2-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) has been investigated in patients with epithelial ovarian cancer and showed promise in diagnosing, staging, detecting recurrent lesions and monitoring treatment response. Conversely, its prognostic role remains unclear. We aimed at assessing the prognostic value of (18)F-FDG PET/CT performed in the restaging process in a multicentre study.
  
  
  METHODS
  We evaluated 168 patients affected by ovarian carcinoma, who underwent a restaging (18)F-FDG PET/CT. The presence of local recurrences, lymph node involvement and distant metastasis was recorded as well as lesion dimensions, maximum and mean standardized uptake values (SUVmax and SUVmean, respectively). Progression-free survival (PFS) and overall survival (OS) at 3 and 4 years were computed by using Kaplan-Meier curves. Increased odds ratio was assessed using Cox regression analysis testing all lesion parameters measured by PET/CT.
  
  
  RESULTS
  PFS was significantly longer in patients with a negative than a positive restaging PET/CT study (3- and 4-year PFS 64 and 53% vs 23 and 12%, respectively; p < 0.001). Similarly, a negative study was associated with a significantly higher OS rate after 4 years of follow-up (67 vs 25% in negative and positive groups, respectively; p < 0.001). Lymph node or distant involvement were also independently associated with an increased risk of disease progression [hazard ratio (HR) 1.6 and 2.2, respectively; p = 0.003]. Moreover, PET/CT showed an incremental prognostic value compared to the International Federation of Gynecology and Obstetrics (FIGO) staging system. In the analysis of patient subsets, individuals with the same FIGO stage I-II but with negative PET had a significantly better 4-year OS than patients with low FIGO stage but positive PET. This implies that patients with the same FIGO stage can be further prognostically stratified using PET (p = 0.01). At receiver-operating characteristic (ROC) analysis, no thresholds for semiquantitative parameters were predictive of a worse outcome.
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT has an important prognostic value in assessing the risk of disease progression and mortality rate. An efficacious therapy planning might therefore effectively rely on (18)F-FDG PET/CT findings. Semiquantitative data were not proven to be an effective tool to predict disease progression.
authors.affiliation: Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hanover, Germany.
authors.forename: Federico
authors.initials: F
authors.lastname: Caobelli
authors.affiliation: Nuclear Medicine Unit, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy. alongi.pierpaolo@hsr.it.|Nuclear Medicine Department, IRCSS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. alongi.pierpaolo@hsr.it.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Alongi
authors.affiliation: Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Evangelista
authors.affiliation: Nuclear Medicine Department, IRCSS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Picchio
authors.affiliation: Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Saladini
authors.affiliation: Nuclear Medicine Department, Hospital of Udine, Udine, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rensi
authors.affiliation: Nuclear Medicine Department, Hospital of Udine, Udine, Italy.
authors.forename: Onelio
authors.initials: O
authors.lastname: Geatti
authors.affiliation: Nuclear Medicine Department, University of Florence, Florence, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Castello
authors.affiliation: Nuclear Medicine Department, University of Florence, Florence, Italy.
authors.forename: Iashar
authors.initials: I
authors.lastname: Laghai
authors.affiliation: Nuclear Medicine Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Cristina E
authors.initials: CE
authors.lastname: Popescu
authors.affiliation: Nuclear Medicine Department; San Gerardo Hospital, Tecnomed Foundation, University of Milan-Bicocca, Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Dolci
authors.affiliation: Nuclear Medicine Department; San Gerardo Hospital, Tecnomed Foundation, University of Milan-Bicocca, Milan, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Crivellaro
authors.affiliation: Nuclear Medicine Department, Hospital of Treviglio, Treviglio, Bergamo, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Seghezzi
authors.affiliation: Nuclear Medicine Unit, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
authors.forename: Margarita
authors.initials: M
authors.lastname: Kirienko
authors.affiliation: Nuclear Medicine Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Biasi
authors.affiliation: Nuclear Medicine Department, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cocciolillo
authors.affiliation: Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Natale
authors.initials: N
authors.lastname: Quartuccio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000737:chemistry*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; FIGO staging system; Ovarian carcinoma; Prognostic value; Restaging