Identification of Metabolic Biomarkers Using Serial 18F-FDG PET/CT for Prediction of Recurrence in Advanced Epithelial Ovarian Cancer

Abstract

Purpose: To evaluate the prognostic value of metabolic parameters derived from serial 18F fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with advanced epithelial ovarian cancer (EOC).

Methods: Thirteen patients with advanced EOC who received surgical staging and adjuvant platinum-based combination chemotherapy were prospectively enrolled. 18F-FDG PET/CT was performed before and after the surgical staging, and after third cycle of chemotherapy. Tumor glucose metabolism at baseline and its change after operation and third cycle of chemotherapy such as changes of maximum standardized uptake values (ΔSUVmax) via 18F-FDG PET/CT were measured, and assessed regarding their ability to predict recurrence.

Results: Median duration of progression-free survival (PFS) was 25 months (range, 13-34), and although optimal debulking was performed in 10 patients, 5 (38.5%) patients experienced recurrence. Univariate analyses showed significant associations between recurrence and low ΔSUVmax after surgical staging, and low SUVmax change after third cycle of chemotherapy. Multivariate analysis identified low ΔSUVmax after third cycle of chemotherapy as an independent risk factor for recurrence (P=.047, hazard ratio (HR) 16.375, 95% CI 1.041-257.536). Kaplan-Meier survival curves showed that PFS significantly differed in groups categorized based on ΔSUVmax after chemotherapy (P=.001, log-rank test).

Conclusions: 18F-FDG PET/CT allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after chemotherapy. The metabolic response measured as ΔSUVmax after third cycle of chemotherapy appears to be promising predictor of recurrence in patients with advanced EOC.

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Relative changes in 18F–FDG uptake expressed as SUV from baseline, 3 weeks after operation and after third cycle of chemotherapy treatment (CTx) in high and low ΔSUV groups after third cycle of chemotherapy.

Figure 2

Receiver operating characteristic curve analysis for determining the cut-off value for ΔSUV after third cycle of chemotherapy for predicting recurrence. The area under the ROC curve of ΔSUV after third cycle of chemotherapy was 0.875, and −0.8277 was determined as the cut-off value (P = .028, sensitivity 80%, specificity 100%).

Figure 3

The Kaplan–Meier survival graph of ΔSUV after third cycle of chemotherapy and progression-free survival with ΔSUV above (blue line) and below (green line) cut-off value. Low ΔSUV after third cycle of chemotherapy was associated with shorter progression-free survival (P = .001, log-rank test).

Figure 4

Two representative cases. (A) Fifty-five-year old female with FIGO stage IIIC serous ovarian cyst adenocarcinoma. Preoperative maximal standardized uptake value (SUVmax) was 9.7, postoperative SUVmax was 3.1, and postchemotherapy SUVmax was 0.9, and postchemoΔSUVmax was 0.907 which was a relatively high value among enrolled subjects. Recurrence did not occur during the follow-up period. (B) Forty-two-year old female with FIGO stage IIIC serous ovarian cyst adenocarcinoma. Preoperative SUVmax was 10.8, postoperative SUVmax was 6.1, and postchemotherapy SUVmax was 3.0, and postchemoΔSUVmax was 0.722 which was a relatively low value among enrolled subjects. Recurrence occurred 22 months after operation.