Importance of fluorodeoxyglucose-positron emission tomography (FDG-PET) and endoscopic ultrasonography parameters in predicting survival following surgery for esophageal cancer.
OBJECTIVE
To assess the prognostic importance of standardized uptake value (SUV) for 18F-fluorodeoxyglucose (FDG) at positron emission tomography (PET) and of EUS parameters, in esophageal cancer patients primarily treated by surgery.


METHODS
Between October 2002 and August 2004 a prospective cohort study involved 125 patients, with histologically proven cancer of the esophagus, without evidence of distant metastases or locally irresectable disease based on extensive preoperative work-up, and fit to undergo major surgery. Follow-up was complete until October 2006, ensuring a minimal potential follow-up of 25 months.


RESULTS
The median SUV was 0.27 (interquartile range 0.13 - 0.45), and was used as cutoff value between high (n = 62) and low (n = 63) SUV. Patients with a high SUV had a significantly worse disease-specific survival compared with patients with a low SUV (P = 0.04). Tumor location (P = 0.005), EUS T stage (P < 0.001), EUS N stage (P = 0.006) and clinical stage (P < 0.006) were also associated with disease-specific survival. However, in multivariate analysis only EUS T stage appeared to be of independent prognostic significance (P = 0.007).


CONCLUSIONS
In esophageal cancer patients, EUS T stage, EUS N stage, location and SUV of the primary tumor are pretreatment factors that are associated with disease-specific survival. However, only EUS T stage is an independent prognostic factor.
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands. j.m.omloo@amc.uva.nl
J M T
JM
Omloo
G W
GW
Sloof
R
R
Boellaard
O S
OS
Hoekstra
P L
PL
Jager
H M
HM
van Dullemen
P
P
Fockens
J T M
JT
Plukker
J J B
JJ
van Lanschot
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D018572:Disease-Free Survival; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods / Q000401:mortality; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D018579:Patient Selection; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18