Does the value of PET-CT extend beyond pretreatment staging? An analysis of survival in surgical patients with esophageal cancer.
BACKGROUND
Studies of positron emission tomography (PET) have focused mainly on tumor staging. The role of PET in predicting survival has received less attention. We sought to assess the relationship of pretreatment maximum standard uptake value (SUV(max)) to survival in surgical patients with esophageal cancer.


METHODS
The study consisted of 72 esophagectomy patients (60 with adenocarcinoma) undergoing resection between July 2005 and April 2009. PET combined with computed tomography (PET-CT) was performed at a single center, and SUV(max) was recorded prior to any therapy. Survival was assessed at a median follow-up of 19 months.


RESULTS
The median SUV(max) was 6.25. A receiver operating characteristic curve identified SUV(max) 4.5 to optimally discriminate survival. Patients with low SUV(max) (<4.5) had significantly (p = 0.0003) better survival than those with high SUV(max) (>or=4.5). Stage 3 patients with low SUV(max) had significantly better survival (p = 0.0069) than those with high SUV(max). Likewise, N1 disease patients with low SUV(max) had significantly better survival (p = 0.008) than those with high SUV(max). Multivariate analysis identified SUV(max) to be an independent predictor of survival (p = 0.0021).


CONCLUSIONS
Pretreatment PET-CT SUV(max) independently predicts survival in patients with esophageal carcinoma undergoing resection. SUV(max) may be a valuable marker of tumor biology that could potentially be exploited for prognostic and therapeutic purposes.
Division of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
Boris
B
Sepesi
Daniel P
DP
Raymond
Marek
M
Polomsky
Thomas J
TJ
Watson
Virginia R
VR
Litle
Carolyn E
CE
Jones
Rui
R
Hu
Xing
X
Qiu
Jeffrey H
JH
Peters
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed