Caobelli Federico, Alongi Pierpaolo, Evangelista Laura, Picchio Maria, Saladini Giorgio, Rensi Marco, Geatti Onelio, Castello Angelo, Laghai Iashar, Popescu Cristina E, Dolci Carlotta, Crivellaro Cinzia, Seghezzi Silvia, Kirienko Margarita, De Biasi Vincenzo, Cocciolillo Fabrizio, Quartuccio Natale
Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hanover, Germany.
Nuclear Medicine Unit, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
Eur J Nucl Med Mol Imaging. 2016 Mar;43(3):404-13. doi: 10.1007/s00259-015-3184-5. Epub 2015 Sep 18.
Ovarian cancer is the eighth most common malignancy among women and has a high mortality rate. Prognostic factors able to drive an effective therapy are essential. (18)F-Fluoro-2-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) has been investigated in patients with epithelial ovarian cancer and showed promise in diagnosing, staging, detecting recurrent lesions and monitoring treatment response. Conversely, its prognostic role remains unclear. We aimed at assessing the prognostic value of (18)F-FDG PET/CT performed in the restaging process in a multicentre study.
We evaluated 168 patients affected by ovarian carcinoma, who underwent a restaging (18)F-FDG PET/CT. The presence of local recurrences, lymph node involvement and distant metastasis was recorded as well as lesion dimensions, maximum and mean standardized uptake values (SUVmax and SUVmean, respectively). Progression-free survival (PFS) and overall survival (OS) at 3 and 4 years were computed by using Kaplan-Meier curves. Increased odds ratio was assessed using Cox regression analysis testing all lesion parameters measured by PET/CT.
PFS was significantly longer in patients with a negative than a positive restaging PET/CT study (3- and 4-year PFS 64 and 53% vs 23 and 12%, respectively; p < 0.001). Similarly, a negative study was associated with a significantly higher OS rate after 4 years of follow-up (67 vs 25% in negative and positive groups, respectively; p < 0.001). Lymph node or distant involvement were also independently associated with an increased risk of disease progression [hazard ratio (HR) 1.6 and 2.2, respectively; p = 0.003]. Moreover, PET/CT showed an incremental prognostic value compared to the International Federation of Gynecology and Obstetrics (FIGO) staging system. In the analysis of patient subsets, individuals with the same FIGO stage I-II but with negative PET had a significantly better 4-year OS than patients with low FIGO stage but positive PET. This implies that patients with the same FIGO stage can be further prognostically stratified using PET (p = 0.01). At receiver-operating characteristic (ROC) analysis, no thresholds for semiquantitative parameters were predictive of a worse outcome.
(18)F-FDG PET/CT has an important prognostic value in assessing the risk of disease progression and mortality rate. An efficacious therapy planning might therefore effectively rely on (18)F-FDG PET/CT findings. Semiquantitative data were not proven to be an effective tool to predict disease progression.
卵巢癌是女性中第八大常见恶性肿瘤，死亡率很高。能够推动有效治疗的预后因素至关重要。18F-氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）已在上皮性卵巢癌患者中进行了研究，并在诊断、分期、检测复发病变和监测治疗反应方面显示出前景。相反，其预后作用仍不明确。我们旨在通过一项多中心研究评估在再分期过程中进行的18F-FDG PET/CT的预后价值。
我们评估了168例卵巢癌患者，他们接受了再分期18F-FDG PET/CT检查。记录局部复发、淋巴结受累和远处转移的情况以及病变大小、最大和平均标准化摄取值（分别为SUVmax和SUVmean）。使用Kaplan-Meier曲线计算3年和4年的无进展生存期（PFS）和总生存期（OS）。使用Cox回归分析评估PET/CT测量的所有病变参数的比值比增加情况。
再分期PET/CT检查结果为阴性的患者的PFS明显长于阳性患者（3年和4年PFS分别为64%和53%，而阳性患者分别为23%和12%；p<0.001）。同样，在随访4年后，检查结果为阴性的患者的OS率明显更高（阴性和阳性组分别为67%和25%；p<0.001）。淋巴结或远处受累也与疾病进展风险增加独立相关[风险比（HR）分别为1.6和2.2；p=0.003]。此外，与国际妇产科联合会（FIGO）分期系统相比，PET/CT显示出增加的预后价值。在患者亚组分析中，FIGO分期为I-II且PET检查结果为阴性的个体的4年OS明显优于FIGO分期低但PET检查结果为阳性的患者。这意味着可以使用PET对FIGO分期相同的患者进行进一步的预后分层（p=0.01）。在接受者操作特征（ROC）分析中，半定量参数的阈值均不能预测更差的结果。
18F-FDG PET/CT在评估疾病进展风险和死亡率方面具有重要的预后价值。因此，有效的治疗计划可能有效地依赖于18F-FDG PET/CT的检查结果。半定量数据未被证明是预测疾病进展的有效工具。
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