title: The impact of intratumoral metabolic heterogeneity on postoperative recurrence and survival in resectable esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To evaluate the impact of intratumoral metabolic heterogeneity measured by 18F-FDG PET imaging on postoperative recurrence and survival for patients with esophageal squamous cell carcinoma (ESCC).
  
  
  RESULTS
  AUC-CSH, metabolic tumor volume and pN-stage were significant prognostic factors for RFS. Additionally, tumor recurrence of the low AUC-CSH group (≤ 0.478) was 3 times higher than high group (P = 0.015). The median OS of patients with advanced AJCC stage or low AUC-CSH was also significantly shorter than that of patients with stage I & II or high AUC-CSH (P = 0.021, 0.009). Multivariate analysis identified the AUC-CSH to be the only significant risk factor for postoperative recurrence and overall survival in whole-group and stage III patients.
  
  
  METHODS
  116 ESCC patients who underwent staging 18F-FDG PET-CT scan and surgical resection were reviewed. The metabolic parameters were assessed as follows: maximum standardized uptake value (SUVmax), metabolic tumor volume, and the area under the curve of the cumulative SUV-volume histogram (AUC-CSH), which is known to reflect the intratumoral metabolic heterogeneity. Regression analyses were used to identify clinicopathological and imaging variables associated with relapse-free survival (RFS) and overall survival (OS).
  
  
  CONCLUSIONS
  Intratumoral metabolic heterogeneity characterized by AUC-CSH can predict postoperative recurrence and survival in patients with resectable ESCC.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China.|Key Laboratory of Radiation Oncology of Shandong Province, Shandong Academy of Medical Sciences, Jinan, Shandong, China.
authors.forename: Xinzhe
authors.initials: X
authors.lastname: Dong
authors.affiliation: Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Xiaorong
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Xianguang
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Wanqi
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Jinan University, Jinan, Shandong, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Wenwu
authors.initials: W
authors.lastname: Li
authors.affiliation: College of Physics and Electronic Science, Shandong Normal University, Jinan, Shandong, China.
authors.forename: Honglin
authors.initials: H
authors.lastname: Wan
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China.|Key Laboratory of Radiation Oncology of Shandong Province, Shandong Academy of Medical Sciences, Jinan, Shandong, China.
authors.forename: Ligang
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China.|Key Laboratory of Radiation Oncology of Shandong Province, Shandong Academy of Medical Sciences, Jinan, Shandong, China.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011183:Postoperative Complications; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000378:metabolism; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG; esophageal carcinoma; intratumoral heterogeneity; positron emission tomography; prognosis