title: Prognostic significance of SUV on PET/CT in patients with localised oesophagogastric junction cancer receiving neoadjuvant chemotherapy/chemoradiation:a systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of this study was to comprehensively review the evidence for use of pre-treatment, post-treatment and changes in tumour glucose uptake that were assessed by 18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) early, during or immediately after neoadjuvant chemotherapy/chemoradiation to predict prognosis of localised oesophagogastric junction (AEG) cancer.
  
  
  METHODS
  We searched for articles published in English; limited to AEG; (18)F-FDG uptake on PET performed on a dedicated device; dealt with the impact of standard uptake value (SUV) on survival. We extracted an estimate of the log hazard ratios (HRs) and their variances and performed meta-analysis.
  
  
  RESULTS
  798 patients with AEG were included. And the scan time for (18)F-FDG-PET was as follows: prior to therapy (PET1, n=646), exactly 2 weeks after initiation of neoadjuvant therapy (PET2, n=245), and pre-operatively (PET3, n=278). In the two meta-analyses for overall survival, including the studies that dealt with reduction of tumour maximum SUV (SUV(max)) (from PET1 to PET2/PET3 and from PET1 to PET2), the results were similar, with the overall HR for non-responders being 1.83 [95% confidence interval (CI), 1.41-2.36] and 2.62 (95% CI, 1.61-4.26), respectively; as for disease-free survival, the combined HR was 2.92 (95% CI, 2.08-4.10) and 2.39 (95% CI, 1.57-3.64), respectively. The meta-analyses did not attribute significant prognostic values to SUV(max) before and during therapy in localised AEG.
  
  
  CONCLUSIONS
  Relative changes in FDG-uptake of AEG are better prognosticators. Early metabolic changes from PET1 to PET2 may provide the same accuracy for prediction of treatment outcome as late changes from PET1 to PET3.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Provincial KeyLaboratory of Rodiation Oncology, Jinan, China.
authors.forename: W
authors.initials: W
authors.lastname: Zhu
authors.forename: L
authors.initials: L
authors.lastname: Xing
authors.forename: J
authors.initials: J
authors.lastname: Yue
authors.forename: X
authors.initials: X
authors.lastname: Sun
authors.forename: X
authors.initials: X
authors.lastname: Sun
authors.forename: H
authors.initials: H
authors.lastname: Zhao
authors.forename: J
authors.initials: J
authors.lastname: Yu
mesh_terms: D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging*; D006801:Humans; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome