Pretreatment 18F-FDG PET/CT-Derived Parameters in Predicting Clinical Outcomes of Locally Advanced Upper Third Esophageal Squamous Cell Carcinoma After Definitive Chemoradiation Therapy

다국어 초록 (Multilingual Abstract)

Purpose The aim of this study was to investigate whether standard uptake values (SUVs) of pretreatment 18F-FDG PET/CT were the surrogate parameters for predicting the outcomes in locally advanced esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy.
Materials and Methods Sixty patients with esophageal squamous cell carcinoma underwent pretreatment 18F-FDG PET/CT and received definitive chemoradiotherapy. 18F-FDG metabolic parameters including SUVmax, SUVmean, SULpeak, total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of primary tumor were calculated. The receiver-operating characteristic (ROC) curve was used to determine the optimal cutoff value of FDG PET/CT-derived parameters that associated with treatment response. Estimating progression-free survival (PFS) and overall survival (OS) was analyzed by using Kaplan–Meier methods. Univariate and multivariate analysis for PFS and OS was performed using Cox regression.
Results Complete response was achieved in 38.3%. The 4-year OS and PFS rates were 48.6% and 44.4%, respectively.
SUVmean with a cutoff value of 6.1 could predict complete response with sensitivity of 69.6%, specificity of 78.4%, and accuracy of 75%. Cox multi-factor regression analyses revealed SUVmean > 6.1 as an independent prognostic factor for OS (HR = 6.74, p = 0.02) and PFS (HR = 6.53, p < 0.001).
Conclusions Our study suggests that SUVmean of the primary tumor in pretreatment 18F-FDG PET/CT may be used as an independent predictor in esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy.

참고문헌 (Reference)

1 Takahashi N, "Whole-body total lesion glycolysis is an independent predictor in" 129 (129): 161-165, 2018

2 Larson SM, "Tumor treatment response based on visual and quantitative changes in global tumor glycolysis using PET-FDG imaging. The visual response score and the change in total lesion glycolysis" 2 (2): 159-171, 1999

3 Burmeister BH, "Thirty-four patients with carcinoma of the cervical esophagus treated with chemoradiation therapy" 126 (126): 205-208, 2000

4 Chen GZ, "The mechanisms of radioresistance in esophageal squamous cell carcinoma and current strategies in radiosensitivity" 9 (9): 849-859, 2017

5 Nakajo M, "Texture analysis of(18)F-FDG PET/CT to predict tumour response and prognosis of patients with esophageal cancer treated by chemoradiotherapy" 44 (44): 206-214, 2017

6 Koopman D, "SUV variability in EARL-accredited conventional and digital PET" 9 (9): 106-, 2019

7 Nahmias C, "Reproducibility of standardized uptake value measurements determined by 18F-FDG PET in malignant tumors" 49 (49): 1804-1808, 2008

8 Suzuki A, "Prognostic significance of baseline positron emission tomography and importance of clinical complete response in" 117 (117): 4823-4833, 2011

9 Han S, "Prognostic Value of Volumetric Parameters of Pretreatment 18F-FDG PET/CT in Esophageal Cancer : A Systematic Review and Meta-analysis" 43 (43): 887-894, 2018

10 van Hagen P, "Preoperative chemoradiotherapy for esophageal or junctional cancer" 366 (366): 2074-2084, 2012

11 Rizk NP, "Predictive value of initial PET-SUVmax in" 4 (4): 875-879, 2009

12 Atsumi K, "Prediction of outcome with FDG-PET in definitive chemoradiotherapy for esophageal cancer" 54 (54): 890-898, 2013

13 Cervino AR, "Positron emission tomography/computed tomography and esophageal cancer in the clinical practice : How does it affect the prognosis?" 8 (8): 619-625, 2012

14 Kato K, "Phase II study of chemoradiotherapy with 5-fluorouracil and cisplatin for Stage II-III esophageal squamous cell carcinoma:JCOG trial (JCOG 9906)" 81 (81): 684-690, 2011

15 Blom RL, "PET/CT-based metabolic tumour volume for response prediction of neoadjuvant chemoradiotherapy in oesophageal carcinoma" 40 (40): 1500-1506, 2013

16 Bruzzi JF, "PET/CT of esophageal cancer : its role in clinical management" 27 (27): 1635-1652, 2007

17 Lagergren J, "Oesophageal cancer" 390 (390): 2383-2396, 2017

18 Piessen G, "Is there a role for surgery for patients with a complete clinical response after chemoradiation for esophageal cancer? An intention-to-treat case-control study" 258 (258): 793-799, 2013

19 Gopal A, "Intratumoral Metabolic Heterogeneity and Other Quantitative (18)F-FDG PET/CT Parameters for Prognosis Prediction in Esophageal Cancer" 3 (3): e200022-, 2021

20 Lu J, "Impact of PET/CT on radiation treatment in" 107 : 128-137, 2016

21 Chen AP, "Grading dermatologic adverse events of cancer treatments:the Common Terminology Criteria for Adverse Events Version 4.0" 67 (67): 1025-1039, 2012

22 Li C, "Good prediction of treatment responses to neoadjuvant chemoradiotherapy for esophageal cancer based on preoperative inflammatory status and tumor glucose metabolism" 11 (11): 11626-, 2021

23 Boellaard R, "FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0" 42 (42): 328-354, 2015

24 Rustgi AK, "Esophageal carcinoma" 371 (371): 2499-2509, 2014

25 Vatankulu B, "Does Metastatic lymph node SUVmax predict survival in" 24 (24): 120-127, 2015

26 Anderluh F, "Definitive radiochemotherapy in esophageal cancer - a single institution experience" 53 (53): 480-487, 2019

27 Versteijne E, "Definitive chemoradiation for patients with inoperable and/or unresectable esophageal cancer: locoregional recurrence pattern" 28 (28): 453-459, 2015

28 Hofheinz F, "Confirmation of the prognostic value of pretherapeutic tumor SUR and MTV in" 46 (46): 1485-1494, 2019

29 Cooper JS, "Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85–01)" 281 (281): 1623-1627, 1999

30 Stahl M, "Chemoradiation with and without surgery in" 23 (23): 2310-2317, 2005

31 Hatt M, "Baseline (1)(8)F-FDG PET image-derived parameters for therapy response prediction in oesophageal cancer" 38 (38): 1595-1606, 2011

32 Milenović Ž, "Application of Mann-Whitney U test in research of professional training of primary school teachers" 6 (6): 73-79, 2011

33 Adams MC, "A systematic review of the factors affecting accuracy of SUV measurements" 195 (195): 310-320, 2010

34 Ando N, "A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus(JCOG9907)" 19 (19): 68-74, 2012

35 Ding X, "A meta-analysis of lymph node metastasis rate for patients with thoracic oesophageal cancer and its implication in delineation of clinical target volume for radiation therapy" 85 (85): e1110-e1119, 2012

36 Rice TW, "7th edition of the AJCC Cancer Staging Manual : esophagus and esophagogastric junction" 17 (17): 1721-1724, 2010

37 Hatt M, "18F-FDG PET uptake characterization through texture analysis : investigating the complementary nature of heterogeneity and functional tumor volume in a multi-cancer site patient cohort" 56 (56): 38-44, 2015

38 Mantziari S, "(18)F- FDG PET/CT-derived parameters predict clinical stage and prognosis of esophageal cancer" 20 (20): 7-, 2020

39 Grabowski B, ""P < 0.05" Might not mean what you think:American statistical association clarifies P values" 108 (108): 2016