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Positron Emission Tomography/Computed Tomography Predictors of Overall Survival in Stage IIIC/IV Ovarian Cancer
  1. Signe Risum, MD, PhD*,
  2. Annika Loft, MD, PhD,
  3. Svend Aage Engelholm, MD, DSc,
  4. Estrid Høgdall, PhD§,
  5. Anne Kiil Berthelsen, MD,
  6. Lotte Nedergaard, MD, PhD,
  7. Lene Lundvall, MD and
  8. Claus Høgdall, MD, DSc
  1. *Department of Oncology, Rigshospitalet, Copenhagen University Hospital,
  2. PET & Cyclotron Unit, Department of Clinical Physiology, Nuclear Medicine & PET, Centre of Diagnostic Investigations, Rigshospitalet, Copenhagen University Hospital, and
  3. Department of Oncology, the Finsen Center, Rigshospitalet, Copenhagen University Hospital;
  4. §Department of Pathology, Danish Cancer Biobank, Herlev Hospital, Copenhagen University Hospital;
  5. Department of Pathology, Centre of Diagnostic Investigations, Rigshospitalet, Copenhagen University Hospital, and
  6. Gynecologic Clinic, the Juliane-Marie Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  1. Address correspondence and reprint requests to Signe Risum, MD, PhD, Department of Oncology, 5073, the Finsen Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail: signerisum{at}


Objective To evaluate the role of 2-deoxy-2-(18F)fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) for selecting patients with extensive ovarian cancer (OC) for neoadjuvant chemotherapy by evaluating predictors of overall survival in patients with stage IIIC/IV OC.

Materials and Methods From September 1, 2004, to November 20, 2011, 514 consecutive patients with a pelvic tumor underwent preoperative PET/CT; 179 patients had stage IIIC/IV OC. Patients’ characteristics were collected from 153 patients with stage IIIC/IV OC who underwent primary surgery. In 152 patients with stage IIIC/IV OC, clinical predictors and PET/CT predictors of survival were evaluated.

Results Median age was 64 years (range, 38–88 years); 87% (113) of the 153 patients had a performance status of less than 2; 55% (84) of the 153 patients had PET/CT stage III, and 45% (69) of the 153 patients had PET/CT stage IV. Using univariate analysis, incomplete debulking (P = 0.0001), pleural exudates (P = 0.001), postmenopausal state (P = 0.01), WHO performance status greater than 2 (P = 0.01), PET/CT stage IV (P = 0.01), and large bowel mesentery implants (P = 0.02) were statistically significant prognostic variables. Using multivariate Cox regression analysis, incomplete debulking was the only statistically significant independent prognostic variable (P = 0.0001). Median overall survival was significantly longer in the 53 patients with no residual tumor than in the 99 patients with residual tumor (33.3 vs 25.5 months; P = 0.0001)

Conclusion Suggested PET/CT criteria for referral of patients with advanced OC to neoadjuvant chemotherapy are PET/CT stage IV, pleural exudates, and PET-positive large bowel mesentery implants. Evaluation of selection criteria for neoadjuvant chemotherapy should be promoted in prospective clinical trials, with survival as the primary end point.

  • Ovarian cancer
  • PET/CT
  • Neoadjuvant chemotherapy
  • Predictors
  • Survival

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