The clinical application of (18)F-fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer.
BACKGROUND
Metabolic tumor activity using (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) was believed to have a predictive value for patient outcome in malignancies. The objective of the current study was to assess the prognostic effectiveness of the highest standardized uptake value (SUV) in the primary or regional area (peak SUV) and the number of PET-positive lymph nodes in esophageal cancer.


METHODS
The authors retrospectively reviewed their experience with 184 consecutive esophageal cancer patients imaged preoperatively using FDG-PET scanning.


RESULTS
The median peak SUV was 4.5 (range, 1.4-21.9). The survival curve was analyzed using the median peak SUV as the cutoff value. Comparison of each group and clinicopathologic characteristics revealed significant associations between peak SUV and each of the following factors: tumor status (P < .001), lymph node status (P < .001), metastatic status (P < .05), stage of disease (P < .001), number of PET-positive lymph nodes (P < .001), and the number of histologically positive lymph nodes (P < .001). The 5-year overall survival (OS) rate for patients having FDG uptake with a peak SUV > or =4.5 was 47% and that for patients with a peak SUV <4.5 was 76% (P < .0001). On multivariate survival analysis using the Cox proportional hazards model, peak SUV and the number of PET-positive lymph nodes were found to be independent predictive factors for OS. The number of PET-positive lymph nodes was a single prognostic factor predicting both disease-free survival and OS.


CONCLUSIONS
Pretreatment PET cannot only potentially diagnose the extent of disease, but also may be predictive of patient survival after esophageal cancer resection.
Kato
Hiroyuki
H
Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, Maebashi, Japan. hkato@dokkyomed.ac.jp
Nakajima
Masanobu
M
Sohda
Makoto
M
Tanaka
Naritaka
N
Inose
Takanori
T
Miyazaki
Tatsuya
T
Fukuchi
Minoru
M
Oriuchi
Noboru
N
Endo
Keigo
K
Kuwano
Hiroyuki
H
D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18