title: Prognostic value of volumetric PET parameters in unresectable and metastatic esophageal cancer.
abstract: OBJECTIVE
  To assess the prognostic value of volumetric parameters measured with PET/CT in patients with advanced or metastatic esophageal cancer (EC).
  
  
  METHODS
  We identified 71 patients (33 adenocarcinoma [AC] and 38 squamous cell carcinoma [ESCC]) with unresectable or metastatic EC who had PET/CT prior to palliative treatment. Volumetric parameters (metabolic tumor volume [MTV], total lesion glycolysis [TLG], tumor length [TL]) as well as maximum and mean standardized uptake (SUVmax, SUVmean) were obtained from (18)F-FDG PET/CT studies. The correlation between overall survival (OS) and established clinical parameters was assessed using a Cox proportional hazards model.
  
  
  RESULTS
  ESCC patients had higher SUVmax and SUVmean compared to AC (p=0.002 and p<0.001, respectively). There was an association of lower SUVmax and SUVmean with metastatic compared to locally advanced tumors (e.g., median SUVmax stage IV: 14.9, 95% confidence interval [95% CI 4.4-35.5] vs. stage IIIA-C: 23.3 [9.2-40.6], p=0.017). TL, MTV and TLG showed an association to OS for all patients and for the subgroup of AC patients (AC; TL: Hazard ratio [HR] 3.23, [95% CI 1.03-10.11], p=0.044; MTV: HR 3.16, [95% CI 1.08-9.23], p=0.035). There was no correlation between PET parameters and survival in ESCC patients. Clinical nodal status was the only clinical variable associated to OS (HR 2.45 [95% CI 1.26-4.75], p=0.008) in AC patients. In a multivariate analysis, nodal status and MTV remained as independent factors associated to OS (N: HR 9.98, [95% CI 1.28-78.11], p=0.028; MTV: HR 1.02, [95% CI 1.01-1.03], p=0.003).
  
  
  CONCLUSIONS
  MTV predicted poor OS in patients with advanced AC. No PET parameters were associated to OS in ESCC patients.
authors: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: dietmar.tamandl@meduniwien.ac.at.
authors: Dietmar
authors: D
authors: Tamandl
authors: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors: Julie
authors: J
authors: Ta
authors: Department of Radiation Oncology, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
authors: Rainer
authors: R
authors: Schmid
authors: Department of Medicine I, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
authors: Matthias
authors: M
authors: Preusser
authors: Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
authors: Matthias
authors: M
authors: Paireder
authors: Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
authors: Sebastian F
authors: SF
authors: Schoppmann
authors: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors: Alexander
authors: A
authors: Haug
authors: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors: Ahmed
authors: A
authors: Ba-Ssalamah
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden
keywords: F18-PET/CT; Metabolic tumor volume; Oesophageal cancer; Outcome analysis; SUV