Abstract
Relevance: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, with relapse occurring in about 70% of
 advanced cases with poor prognosis.
 The study aimed to assess functional visceral fat activity (VAT) evaluated by 18F-fluorodeoxyglucose (18F-FDG) positron emission
 tomography/computed tomography (PET/CT) as a predictor of metastases in epithelial ovarian cancer.
 Methods: We assessed 53 patients with histologically confirmed EOC who underwent 18F-FDG PET/CT after a surgical treatment and
 courses of chemotherapy. Age, histology, stage, and tumor grade were recorded. Functional VAT was measured by maximum standardized
 uptake value (SUVmax) using 18F-FDG PET/CT and tested as a predictor of later metastases in eight abdominal locations and pelvis cavity
 in the adjusted regression models. We also identified the best areas under the curve (AUC) for SUVmax with the corresponding sensitivity
 (Se) and specificity (Sp).
 Results: In both adjusted for regression models and ROC analysis, 18F-FDG accumulation in RE (cut-off SUVmax 1.18; Se 64%; Sp
 64%; AUC 0.669; p=0.035) could predict later metastases in EOC patients, as opposed to age, sex, primary tumor location, tumor grade,
 and histology.
 Conclusions: VAT SUVmax is significantly associated with later metastases in EOC patients and can be used as their predictor
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