title: Posttreatment FDG PET/CT in predicting survival of patients with ovarian carcinoma.
abstract: BACKGROUND
  The purposes of this study are to evaluate the prognostic value of posttreatment (18)F-FDG PET/CT in predicting the survival of patients with ovarian carcinoma and to determine incremental value of combining posttreatment PET/CT with traditional prognostic factors in a multivariate model.
  
  
  METHODS
  This was an IRB-approved retrospective study. From July 2001 to July 2011, 48 patients who completed initial therapy for ovarian carcinoma with concurrent 3- to 9-month initial posttreatment (18)F-FDG PET/CT and serum CA-125 were identified from the radiology database. Prognostic value of posttreatment PET/CT, CA-125, age, race, and tumor stage were determined from Cox proportional hazard model using univariate and multivariate analyses. Time-dependent receiver operator curves were also calculated at various follow-up intervals.
  
  
  RESULTS
  In a univariate model, overall survival (OS) was associated with PET/CT (hazard ratio = 4.18; 95 % CI 1.49-11.70) and CA-125 (hazard ratio = 11.09; 95 % CI 4.27-28.79). When the effects of posttreatment PET/CT and CA-125 were combined in the multivariate analysis, hazard ratio for PET/CT increased to 4.84 (95 % CI 1.59-14.73, p = 0.005) and hazard ratio for CA-125 increased to 14.43 (95 % CI 4.65-44.84, p < 0.001). In the subset of patients with negative CA-125, posttreatment PET/CT had a hazard ratio of 2.98 (95 % CI 0.86-10.37), supporting the role of posttreatment PET/CT in risk stratification of patients with negative CA-125. Time-dependent receiver operator curves showed that the combination of PET/CT and CA-125 improved prognostic accuracy compared to PET/CT or CA-125 alone at 12-, 24-, 30-, and 36-month follow-up.
  
  
  CONCLUSIONS
  Posttreatment PET/CT can predict the survival of patients with ovarian carcinoma. The addition of posttreatment PET/CT to the CA-125 serum biomarker has an incremental value in improving prognostic accuracy, particularly in the subset of patients with negative CA-125.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA. lindachu@jhmi.edu.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Chu
authors.affiliation: Johns Hopkins Division of Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD, 21287, USA.
authors.forename: Hua-Ling
authors.initials: HL
authors.lastname: Tsai
authors.affiliation: Johns Hopkins Division of Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD, 21287, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.|Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 660S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors.forename: John
authors.initials: J
authors.lastname: Crandall
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
authors.forename: Mehrbod S
authors.initials: MS
authors.lastname: Javadi
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.|Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 660S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wahl
keywords: CA-125; Ovarian carcinoma; PET/CT; Patient survival; Prognosis