Abstract
ObjectiveTo evaluate the impact of intratumoral metabolic heterogeneity measured by 18F-FDG PET imaging on postoperative recurrence and survival for patients with esophageal squamous cell carcinoma (ESCC).ResultsAUC-CSH, metabolic tumor volume and pN-stage were significant prognostic factors for RFS. Additionally, tumor recurrence of the low AUC-CSH group (≤ 0.478) was 3 times higher than high group (P = 0.015). The median OS of patients with advanced AJCC stage or low AUC-CSH was also significantly shorter than that of patients with stage I & II or high AUC-CSH (P = 0.021, 0.009). Multivariate analysis identified the AUC-CSH to be the only significant risk factor for postoperative recurrence and overall survival in whole-group and stage III patients.Materials and Methods116 ESCC patients who underwent staging 18F-FDG PET-CT scan and surgical resection were reviewed. The metabolic parameters were assessed as follows: maximum standardized uptake value (SUVmax), metabolic tumor volume, and the area under the curve of the cumulative SUV-volume histogram (AUC-CSH), which is known to reflect the intratumoral metabolic heterogeneity. Regression analyses were used to identify clinicopathological and imaging variables associated with relapse-free survival (RFS) and overall survival (OS).ConclusionsIntratumoral metabolic heterogeneity characterized by AUC-CSH can predict postoperative recurrence and survival in patients with resectable ESCC.
Highlights
Apart from the high incidence rate, esophageal carcinoma is one of the sixth leading causes of cancerrelated deaths in the world [1]
Regression analyses were used to identify clinicopathological and imaging variables associated with relapse-free survival (RFS) and overall survival (OS)
As shown in multivariate COX regression analyses (Table 3), AUC-Cumulative SUV volume histogram (CSH) was the only independent prognostic factors of RFS (P = 0.008; HR: 3.153 95% CI: 2.873–4.821)
Summary
Apart from the high incidence rate, esophageal carcinoma is one of the sixth leading causes of cancerrelated deaths in the world [1]. It is known that Asian countries have the highest rates of esophageal cancer [2]. Compared with other types of esophageal carcinoma (mainly adenocarcinoma), esophageal squamous cell carcinoma (ESCC) has a poorer long-term survival. Esophagectomy has historically been considered the mainstay of treatment but has disappointing long-term outcomes [3]. Intratumoral heterogeneity is a well-recognized feature of malignancy tumor. A measurement that can quantify intratumoral heterogeneity may potentially predict outcome of ESCC. Positron emission tomography (PET) with 18F-fluorodeoxy glucose (18F-FDG) reflects important functional information on tumor cells. There is an increasing interest in using 18F-FDG PET images to quantify tumor tracer uptake heterogeneity and predicting treatment outcome non-invasively [5]
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