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Abstract
Introduction/Background To study if any metabolic biomarker of the staging 18F-FDG-PET/CT is related to the therapeutic strategy performed in high-grade serous ovarian cancer (HGSC) patients.
Sample characteristics. Table 2 – Multivariate logistic regression model – Image: 18F-FDG-PET/CT staging maximum intensity projections (MIP). A) The MIP image shows a bilateral high-grade serous ovarian cancer process with lymph node involvement (supra and infradiaphragmatic) and peritoneal carcinomatosis. B) Segmentation of the supradiaphragmatic (orange segmented lymph nodes) and infradiaphragmatic (green segmented primary tumor, pink segmented peritoneal carcinomatosis, and yellow segmented infradiaphragmatic lymph nodes) disease.
Methodology Retrospective review of HGSC patients who underwent a staging 18F-FDG-PET/CT before deciding the therapeutic strategy: A (primary cytoreduction) or B [neoadjuvant chemotherapy (NACT) and interval cytoreduction]. Metabolic biomarkers studied were metabolic active tumor volumen(MTV) and total lesion glycolysis(TLG). 18F-FDG-PET/CT parameters were obtained by means of the segmentation of the supradiaphragmatic disease and the different abdominal areas (primary tumor, peritoneal carcinomatosis and infradiaphragmatic lymph nodes) with automatic thresholding at 30% of SUVmax. The presence of ascites with pathological uptake of 18F-FDG was collected, as well as age, basal CA-125(U/mL), and complete/incomplete cytoreduction. The dependent variable was the therapeutic strategy performed. Data were described by median[IQR] and by frequency(%). Chi-square and Mann-Whitney U tests were used to compare groups and ROC analysis to dichotomize continuous variables. Predictors of the therapeutic strategy were analyzed using multiple logistic regression analysis.
Results Fourty-two patients were included, 25 in group A and 17 in group B. Both groups were similar in relation to median age(61 years[56–66] vs. 65[58–71]; p=0,155), median basal CA-125 (667 U/mL[43–1113] vs 840 U/mL [99–1778]; p=0.289), and frequency of complete cytoreduction(68 vs 88.2%; p=0.102). Group A shows significantly less ascites with pathological uptake(32 vs 76.5%; p=0.005) and smaller MTV and TLG values for supradiaphragmatic disease(0 [0–0] vs 8.7 [3.9–55.0] and 0 [0–0] vs 25.5 [11.4–132.0], respectively). NACT and interval cytoreduction were predicted by both ascites with pathological uptake(OR=5.088; 95%CI: 1.157–22.382; p=0.031) and TLG values >1,324 for infradiaphragmatic disease(OR=4.448; 95%CI: 1.037–19.074; p=0.044),or by supradiaphragmatic disease TLG >6.6(OR=24.500; ; 95%CI: 4.740–126.632; p<0.001).
Conclusion Despite the small sample size, this study identifies 18F-FDG PET/CT biomarkers useful for decision-making on the therapeutic strategy to be followed in patients with HGSC.
Disclosures Nothing to disclose.