Prognostic Value of Pretreatment ¹⁸F-FDG-PET/CT Metabolic Parameters in Advanced High-Grade Serous Ovarian Cancer

To assess the prognostic value of pretreatment ¹⁸F-FDG-PET/CT quantitative metabolic parameters in patients with advanced high-grade serous ovarian cancer (HGSOC).

A review of 47 patients diagnosed with advanced HGSOC between 2012 and 2020 in our center was performed, evaluating pretreatment ¹⁸F-FDG-PET/CT metabolic parameters: maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG) and metabolic tumoral volume (MTV). Two experienced nuclear medicine physicians evaluated the images, thereby obtaining quantitative parameters semiautomatically classifying the volume of interest (VOI) as the target (t): VOI with the highest SUVmax normalized by lean body mass (SUVmax(lbm)), non target (nt) and total (sum of target and non-target VOIs). The disease-free survival (DFS) and overall survival (OS) were calculated. Optimal cutoff values with ROC curves/median values were used. The Correlation between metabolic parameters and DFS/OS was determined using univariate and survival-curves analysis.

The median DFS was 18 months (2.5-55) and the OS 33.6 months (2.5-92). The MTVtotal, MTV(t), TLGtotal and TLG(t) were significantly associated with DFS (p = 0.005, 0.01, 0.04 and 0.04, respectively). The patients with MTVtotal > 427.8 cm³ and MTVtarget > 434 cm³ had shorter DFS than the patients with lower values (18.8 versus 31 months and 15.6 versus 30, p = 0.02 and 0.01, respectively). The patients with higher TLGtotal and TLG(t) values tended to have worse DFS (p = 0.26 and 0.31, respectively). In a multivariate analysis, the MTVtotal was statistically significantly associated with DFS (p = 0.003). No correlation was found with OS.

Pretreatment MTVtotal and MTV(t) appear to be predictive of relapse in patients with advanced HGSOC.