title: A systematic review of the predictive value of (18)FDG-PET in esophageal and esophagogastric junction cancer after neoadjuvant chemoradiation on the survival outcome stratification.
abstract: OBJECTIVE
  We studied the predictive value of [(18) F]fluorodeoxyglucose-positron emission tomography ((18)FDG-PET) for assessing disease-free (DFS) and overall survival (OS) in esophageal and esophagogastric junction cancer.
  
  
  METHODS
  A literature search (PUBMED/MEDLINE, EMBASE, Cochrane) was performed to identify full papers with (18)FDG-PET and survival data, using indexing terms and free text words. Studies with >10 patients with locally advanced esophageal cancer, presenting sequential or at least one post-adjuvant treatment (18)FDG-PET data and Kaplan-Meier survival curves with >6 months median follow-up period were included. We performed a meta-analysis for DFS and OS using the hazard ratio (HRs) as outcome measure. Sources of heterogeneity study were also explored.
  
  
  RESULTS
  We identified 26 eligible studies including a total of 1,544 patients (average age 62 years, 82% males). The TNM distribution was as follows: stage I 7%, II 24%, III 53% and IV 15%. The pooled HRs for complete metabolic response versus no response were 0.51 for OS (95% CI, 0.4-0.64; P < 0.00001) and 0.47 for DFS (95% CI, 0.38-0.57; P < 0.00001), respectively. No statistical heterogeneity was present. To explore sources of clinical heterogeneity, we also realised subgroup and regression analyses. Taken into account the moderate correlation between OS and DFS (ρ = 0.54), we used joint bivariate random regression model. These analyses did not show a statistically significant impact of study characteristics and PET modalities on the pooled outcome estimates.
  
  
  CONCLUSIONS
  Despite methodological and clinical heterogeneity, metabolic response on (18)FDG-PET is a significant predictor of long-term survival data.
authors.affiliation: Nuclear Medicine Division, CHU UCL Mont-Godinne - Dinant, Université Catholique de Louvain, 1 Dr Therasse, 5530, Yvoir, Belgium.
authors.forename: Pascaline
authors.initials: P
authors.lastname: Schollaert
authors.forename: Ralph
authors.initials: R
authors.lastname: Crott
authors.forename: Claude
authors.initials: C
authors.lastname: Bertrand
authors.forename: Lionel
authors.initials: L
authors.lastname: D'Hondt
authors.forename: Thierry Vander
authors.initials: TV
authors.lastname: Borght
authors.forename: Bruno
authors.initials: B
authors.lastname: Krug
mesh_terms: D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D015996:Survival Rate
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18