title: Accuracy of PET-CT in predicting survival in patients with esophageal cancer.
abstract: BACKGROUND
  Positron emission tomography (PET) is an integral part of tumor staging for patients with esophageal cancer. Recent studies suggest a role for PET scan in predicting survival in these patients, but this relationship is unclear in the setting of neoadjuvant therapy. We examined pretreatment maximum standard uptake value (SUV(max)) of the primary tumor in patients treated with and without neoadjuvant therapy.
  
  
  METHODS
  All patients undergoing esophagectomy with a preoperative PET scan over a nine-year period (2001-2010) were identified from a prospectively maintained database. Positron emission tomography data were obtained from computers housing the original PET scans. Overall survival was correlated with SUV(max) of the primary tumor.
  
  
  RESULTS
  A total of 191 patients were identified, and 103 patients met inclusion criteria. Eighty-two had an adenocarcinoma (80%), and 21 (20%) had a squamous cell carcinoma. Fifty-seven (55%) patients received neoadjuvant therapy. In the surgery alone group, a SUV(max) of > 5.0 in the primary tumor was associated with poor prognosis [Hazard Ratio (HR) 0.32; p = 0.007], but this factor did not retain its significance on multivariate analysis (HR 0.65; p = 0.43). Pretreatment SUV(max) in patients who underwent neoadjuvant therapy was not significant in predicting overall survival (p = 0.10).
  
  
  CONCLUSIONS
  This study does not support the use of SUV(max) on pretreatment PET scans as a prognostic tool for patients with esophageal cancer, especially in those who have received neoadjuvant therapy. Lymph node status is a more accurate predictor of outcome, and efforts to improve pretreatment staging should focus on this factor.
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Brown
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Howes
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Glyn G
authors.initials: GG
authors.lastname: Jamieson
authors.affiliation: Department of Nuclear Medicine, PET and Bone Densitometry, and Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
authors.forename: Dylan
authors.initials: D
authors.lastname: Bartholomeusz
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Urs
authors.initials: U
authors.lastname: Zingg
authors.affiliation: Discipline of Public Health, University of Adelaide, Adelaide, SA, 5000, Australia.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Sullivan
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia. sarah.thompson@adelaide.edu.au.|Department of Surgery, Royal Adelaide Hospital, Level 5, Eleanor Harrald Building, Adelaide, SA, 5000, Australia. sarah.thompson@adelaide.edu.au.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Thompson
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed