Ability of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography to Predict Outcomes of Neoadjuvant Chemoradiotherapy Followed by Surgical Treatment for Esophageal Squamous Cell Carcinoma.
BACKGROUND
Responses of esophageal cancer to neoadjuvant therapy and patient prognosis are difficult to predict preoperatively. This study aimed to determine the ability of fluorine-18 fluorodeoxyglucose ((18)FDG) positron emission tomography (FDG-PET) to predict outcomes of trimodal therapy on esophageal squamous cell carcinoma (ESCC).


METHODS
The responses of 111 patients with ESCC were monitored using FDG-PET before and after neoadjuvant chemoradiotherapy (nCRT) followed by surgical treatment. Associations between the maximum standardized uptake value (SUVmax) and pathologic responses (PRs) and prognosis were analyzed.


RESULTS
Responses were significantly associated with SUVmax after nCRT (post-SUVmax) and with the rate of decreases in the SUVmax (%ΔSUVmax) of the primary tumor. The optimal cutoffs for post-SUVmax and %ΔSUVmax determined from receiver operating characteristic (ROC) curves were 2.7 (area under the curve [AUC], 0.68; 95% confidence interval [CI], 0.58-0.78; p = 0.001) and 75 (AUC, 0.64; 95% CI, 0.54-0.75; p = 0.01) for predicting a pathologic complete response (pCR) and 3.7 (AUC, 0.76; 95% CI, 0.63-0.89; p < 0.001) and 70 (AUC, 0.65; 95% CI, 0.52-0.78; p = 0.02) for predicting a good response according to Japan Esophageal Society response criteria. These values reliably separated patients into groups with and without pCR and with and without a good response. Multivariate analysis showed that %ΔSUVmax (≤70 and >70) was an independent prognostic factor for disease-specific survival (hazard ratio [HR], 0.45; 95% CI, 0.21-0.98; p = 0.04).


CONCLUSIONS
SUVmax is a valuable preoperative predictor of tumor response and survival among patients who undergo trimodal therapy for ESCC.
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Yoichi
Y
Hamai
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. Electronic address: hihara@hiroshima-u.ac.jp.
Jun
J
Hihara
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Manabu
M
Emi
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Takaoki
T
Furukawa
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Ichiko
I
Yamakita
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Tomoaki
T
Kurokawa
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Morihito
M
Okada
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015996:Survival Rate; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18