Abstract
Purpose: This study aimed to explore whether metabolic responses to 18F-fluorodeoxyglucose positron emission tomography/computed tomography collected before, during, or after the treatment can predict the long-term survival rate of patients with esophageal cancer. Patients and Methods: We searched for the following indices in articles listed in English and Chinese literature databases: the maximum standard uptake value (SUVmax), mean standard uptake value (SUVmean), Metabolic Tumor Volume (MTV), and Total Lesion Glycolysis (TLG). If their values exceeded the thresholds, we defined them as responders; if they did not, we defined them as non-responders. We then performed a meta-analysis by extracting the Hazard Ratio (HR) and 95% confidence interval (95% CI) from each report to predict whether the status of responder or non-responder had an impact on prognosis. Results: We identified 34 articles with a combined sample size of 2794 patients. HRs and 95% CIs were measured as follows: SUVmax = 1.15 (0.98- 1.35), MTV = 3.45 (0.78-15.25), TLG = 1.04 (1.02-1.07), and SUVmean = 1.85 (1.33-2.57) (before treatment); ΔSUVmax = 1.22 (1.06-1.39), Δ MTV = 1.07 (0.54- 2.15), and ΔTLG = 1.09 (0.59-2.02) (during treatment); and SUVmax = 1.13 (1.05- 1.22) and TLG = 1.05 (1.02-1.09) (after treatment). The results showed that the overall survival of the patients with low SUV (MTV, TLG) values was significantly higher than that of the patients with high SUV (MTV, TLG) values. Conclusions: This meta-analysis shows that the prognoses of patients with PET metabolic responses are significantly better than those of non-responders. Our findings may help inform the clinical treatment and prediction of the prognoses of patients with esophageal cancer.
Highlights
Due to differences in economic development and living habits, the incidence of upper gastrointestinal cancer is high in economically underdeveloped areas, especially in East Asia and East Africa [1]
The results showed that the overall survival of the patients with low SUV (MTV, Total Lesion Glycolysis (TLG)) values was significantly higher than that of the patients with high SUV (MTV, TLG) values
This meta-analysis shows that the prognoses of patients with Positron Emission Tomography (PET) metabolic responses are significantly better than those of non-responders
Summary
Due to differences in economic development and living habits, the incidence of upper gastrointestinal cancer is high in economically underdeveloped areas, especially in East Asia and East Africa [1]. The annual incidence of upper gastrointestinal cancer in China, for example, accounts for 44.6% of the global incidence of the disease with a crude mortality rate of 13.68/100000 [2]. Esophageal cancer is one of the most common tumors of the upper digestive system. It is principally treated with a combination of surgery and neoadjuvants or definitive radiotherapy and chemotherapy. While this multimodal treatment has greatly reduced the mortality and improved the disease-free survival rate of patients with esophageal cancer, the accurate prediction of the prognoses of patients following the treatment has remained a challenge [3]. A superb supplement to traditional medical imaging, Positron Emission Tomography (PET) has partially replaced invasive examinations such as endoscopic biopsy as a method of delineating the target area in the early stages of tumor radiotherapy and holds a potential for improving the prediction of a patient’s response to radiotherapy, chemotherapy, and even surgery [4]
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