Value of F-18 FDG PET/CT in the prediction overall survival in advanced ovarian cancer after neoadjuvant chemotherapy

Aim: Value of F-18 FDG PET/CT in the prediction overall survival in advanced ovarian cancer after neoadjuvant chemotherapy

Objectives: Recently, LION trial revealed systematic pelvic and para-aortic lymphadenectomy (LNE) had no benefit in the patients with clinically negative lymph node. In this context, we aimed to evaluate significance of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) assessed metastatic pelvic and para-aortic lymph nodes in the prognosis of advanced ovarian cancer.

Methods: A total 67 women with pathologically confirmed advanced ovarian cancer and underwent neoadjuvant chemotherapy before cytoreductive surgery was retrospectively included. As metabolic parameters, visual analysis of pelvic and para-aortic lymph node and maximum standardized uptake value (SUVmax) were measured and used for the analysis. Predictive values of clinicopathologic and metabolic parameters were compared in terms of ovarian cancer recurrence and survival. Results: Fifty-four patients (80.6%) showed recurrence after cytoreductive surgery. Among clinicopathologic and metabolic parameters, only histological type was significant factor in the prediction of recurrence in both univariate and multivariate analysis. Thirty-two patients died after cytoreductive surgery. Tumor marker (CA125), contrast enhanced computed tomography (CT) finding of nodal metastasis, pathologic nodal metastasis and metabolic finding of nodal metastasis were significant factors for the prediction of overall survival in univariate analysis. However, in the multivariate analysis, serous type of epithelial ovarian cancer (HR 3.15, p=0.0464) and visual analysis of nodal metastasis by FDG PET/CT (HR 3.14, p=0.0033) were significant factors in the prediction of overall survival in multivariate analysis. Conclusion: Metabolic finding of node metastasis in advanced ovarian cancer would help patient management, especially in surgical planning of LNE in terms of patient survival.