PS02.065: UTILITY OF FDG-PET TO PREDICT LONG TERM PROGNOSIS FOR PATIENTS WITH ESOPHAGEAL CANCER RECEIVING NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY SURGERY

Abstract

Abstract Background There are no prognostic factor for patients with esophagectomy using neoadjvant chemoradiotherapy (nCRT) except for the pathological complete response (pCR). This study aimed to determine the ability of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) to predict prognosis of trimodality therapy on esophageal squamous cell carcinoma (ESCC). Methods A series of 90 patients with esophageal squamous cell carcinoma without cervical esophageal underwent sub-total esophagectomy after neoadjvant chemoradiotherapy in the period between October 2006 and January 2013 at our institution. The study included 119 (75 men, 15 women; median age,67) patients with locally advanced ESCC (Stage IB/IIAB/IIIABC/IV: 3/14/64/9). The responses were monitored using FDG-PET before and after nCRT followed by surgery. FDG-PET complete response (PET-CR) after chemoradiotherapy was defined as standardized uptake value less than 2.5. Prognostic factors were determined by uni- and multivariate analysis. Results The 5-year overall survival (OS) rates of all patients were 55.3%. Thirty-nine (43.3%) patients achieved a pathological complete response (pCR) after nCRT. Sixty-five percent achieved a PET-CR. PET-CR did not predict for improved outcomes for trimodality therapy (5-year OS 61.5% vs 43.8% P = 0.137).The optimal cutoffs for the rate of decreases in the maximum standard uptake value (SUVmax) determined from receiver operating characteristic (ROC) curves were 75 (AUC, 0.64; 95% CI, 0.54–0.75; P = 0.01) for predicting a pCR. A nonsignificant association was seen in prognosis at the the rate of decreases in SUVmax (P = 0.0823).The PET negative lymph nodes before treatment group showed a higher OS than in the PET-N positive group (5-Y OS 75.0% vs 46.9% P = 0.0036). Multivariate Cox regression analyses identified pCR (hazard ratio [HR], 3.271; confidence interval [CI], 1.568–6.828) and PET-N negative (HR 0.311, CI 0.163–0.592), as the prognostic factor. Conclusion Analysis of SUVmax of the primary tumor and lymph node before and after nCRT revealed that PET-N positive before treatment is long term prognostic factor. Disclosure All authors have declared no conflicts of interest.