Prognostic value of preoperative intratumoral FDG uptake heterogeneity in patients with epithelial ovarian cancer

Objectives: To investigate the prognostic value of intratumoral FDG uptake heterogeneity (IFH) derived from PET/CT in patients with epithelial ovarian cancer (EOC). Methods: We retrospectively reviewed patients with pathologically proven epithelial ovarian cancer who underwent preoperative ¹⁸F-FDG PET/CT scans. PET/CT parameters such as maximum and average standardized uptake values (SUV_max and SUV_avg), sum of all metabolic tumour volume (MTV), cumulative total lesion glycolysis (TLG) and IFH were assessed. Regression analyses were used to identify clinicopathological and imaging variables associated with disease-free survival (DFS). Results: Clinicopathological data were reviewed for 61 eligible patients. The median duration of DFS was 13 months (range, 6–26 months), and 18 (29.5 %) patients experienced recurrence. High IFH values were associated with tumour recurrence (P = 0.005, hazard ratio 4.504, 95 % CI 1.572–12.902). The Kaplan-Meier survival graphs showed that DFS significantly differed in groups categorized based on IFH (P = 0.002, log-rank test). Moreover, there were significant differences in DFS (P = 0.009) and IFH (P = 0.040) between patients with and without recurrence. Conclusions: Preoperative IFH measured by ¹⁸F-FDG PET/CT was significantly associated with EOC recurrence. FDG-based heterogeneity could be a useful and potential predicator of EOC recurrence before treatment.