title: Prognostic Significance of 2-Deoxy-2-[18F]-Fluoro-D-Glucose PET/CT in Patients With Locally Advanced Esophageal Cancer Undergoing Neoadjuvant Chemoradiotherapy Before Surgery: A Nonparametric Approach.
abstract: To investigate the prognostic value of tumor metabolism measurements on serial 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography and computed tomography scans in patients with locally advanced esophageal cancer undergoing neoadjuvant chemoradiotherapy. Forty-five patients (63 ± 7 years, 6 female) treated with concomitant chemoradiotherapy before surgery were followed up for 24 ± 18 months (range 4-71). Positron emission tomography and computed tomography scans were obtained within 1 week before the start (PET1) and 1 month after the completion of the treatment (PET2). Total body tumor metabolic activity was measured as the sum of the parameters: SUVmax, SUV corrected for lean body mass, and total lesion glycolysis (TLG40/50/70%). Then, delta values for the parameters between PET1 and PET2 were calculated and expressed as percentage of PET1 results. At the time of the analysis, 27 patients were dead and 18 were alive. There was no difference between the 2 groups in terms of age, sex, site of the disease, histology, and the presence/absence of linfonodal metastases (P = NS). Survival random forest analysis (20,000 trees) resulted in an estimate of error rate of 36%. The nonparametric approach identified ΔTLG40 as the most predictive factor of survival (relative importance 100%). Moreover, T (17%), N (5%), and M (5%) stage of the disease, cancer histology (11%), TLG70 (5%) at the end of chemioradioterapy, and ΔTLG(50-70) (17%-5%) were positively associated with patient outcome. The nonparametric analysis confirmed the prognostic importance of some clinical parameters, such as TNM stage and cancer histology. Moreover, ΔTLG resulted to be the most important factor in predicting outcome and should be considered in risk stratification of patients treated with neoadjuvant chemoradiotherapy.
authors.affiliation: From the Fondazione CNR/Regione Toscana "G. Monasterio" (AG, AR, DG, LP, PM), via Moruzzi 1; Azienda Ospedaliera Universitaria Pisana (GP, BS, SD, SS), UOC Chirurgia dell'esofago, via Paradisa 2; Azienda Ospedaliera Universitaria Pisana (ML), UOC Oncologia Medica; and Azienda Ospedaliera Universitaria Pisana (MGF), UOC Radioterapia, via Roma 67, Pisa, Italy.
authors.forename: Assuero
authors.initials: A
authors.lastname: Giorgetti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pallabazzer
authors.forename: Andrea
authors.initials: A
authors.lastname: Ripoli
authors.forename: Biagio
authors.initials: B
authors.lastname: Solito
authors.forename: Dario
authors.initials: D
authors.lastname: Genovesi
authors.forename: Monica
authors.initials: M
authors.lastname: Lencioni
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fabrini
authors.forename: Simone
authors.initials: S
authors.lastname: D'Imporzano
authors.forename: Laura
authors.initials: L
authors.lastname: Pieraccini
authors.forename: Paolo
authors.initials: P
authors.lastname: Marzullo
authors.forename: Stefano
authors.initials: S
authors.lastname: Santi
mesh_terms: D000368:Aged; D001823:Body Composition; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18