title: Metabolic tumor volume provides complementary prognostic information to EUS staging in esophageal and junctional cancer.
abstract: To determine the correlation between 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) derived esophageal tumor parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV)] and endoscopic ultrasound (EUS) derived tumor parameters (T stage, N stage) and their prognostic implications. 150 consecutive patients with cancer of the esophagus or esophagogastric junction underwent staging PET-CT and staging EUS. PET-CT derived SUVmax and MTV of the primary tumor was recorded. EUS evaluated T and N stage. Relationships between parameters were investigated using the Mann-Whitney U tests, survival analysis performed using Kaplan-Meier and independent prognostic factors determined using Cox regression multivariate analysis. A significant difference in MTV was noted between EUS T1/T2 tumors (median 6.7 cm3) and EUS T3/T4 tumors (median 35.7 cm3; P < 0.0001). An MTV of <23.4 cm3 (P = 0.0001), SUVmax < 4.1 (P = 0014), EUS T stage (P < 0.0001), EUS N stage (P < 0.0001), and clinical stage (P < 0.0001) were all significantly associated with survival, with MTV <23.4 cm3 (P = 0.004), EUS T stage (P = 0.01), and EUS N stage (P = 0.01) significant in multivariate analysis. MTV, a volumetric parameter of PET-CT, has more prognostic importance than SUVmax and provides valuable prognostic information in esophageal and junctional cancer, along with EUS T and N stage. MTV provides complementary information to EUS and should be included in the staging of esophageal and junctional cancer.
authors.affiliation: Department of Clinical Surgery, St James's Hospital and Trinity College Dublin, Ireland.
authors.forename: Vinod
authors.initials: V
authors.lastname: Malik
authors.affiliation: Department of Radiology, St James's Hospital and Trinity College Dublin, Ireland.
authors.forename: Ciaran
authors.initials: C
authors.lastname: Johnston
authors.affiliation: Department of Clinical Medicine, St James's Hospital and Trinity College Dublin, Ireland.
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole
authors.affiliation: Department of Medical Physics and Clinical Engineering, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: Julie
authors.initials: J
authors.lastname: Lucey
authors.affiliation: Department of Clinical Surgery, St James's Hospital and Trinity College Dublin, Ireland.
authors.forename: Naoimh
authors.initials: N
authors.lastname: O'Farrell
authors.affiliation: Department of Clinical Surgery, St James's Hospital and Trinity College Dublin, Ireland.
authors.forename: Zieta
authors.initials: Z
authors.lastname: Claxton
authors.affiliation: Department of Clinical Surgery, St James's Hospital and Trinity College Dublin, Ireland.
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging* / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET-CT; endoscopic ultrasound; esophageal cancer; staging