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

PURPOSE. To evaluate the prognostic value of metabolic parameters derived from serial (18)F 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. (18)F–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 (ΔSUV(max)) via (18)F–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 ΔSUV(max) after surgical staging, and low SUV(max) change after third cycle of chemotherapy. Multivariate analysis identified low ΔSUV(max) 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 ΔSUV(max) after chemotherapy (P = .001, log-rank test). CONCLUSIONS. (18)F–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 ΔSUV(max) after third cycle of chemotherapy appears to be promising predictor of recurrence in patients with advanced EOC.