title: Serial imaging using [18F]Fluorodeoxyglucose positron emission tomography and histopathologic assessment in predicting survival in a population of surgically resectable distal oesophageal and gastric adenocarcinoma following neoadjuvant therapy.
abstract: OBJECTIVE
  We retrospectively evaluated the value of PET/CT in predicting survival and histopathological tumour-response in patients with distal oesophageal and gastric adenocarcinoma following neoadjuvant treatment.
  
  
  METHODS
  Twenty-one patients with resectable distal oesophageal adenocarcinoma and 14 with gastric adenocarcinoma between January 2002 and December 2011, who had undergone serial PET before and after neoadjuvant therapy followed by surgery, were enrolled. Maximum standard uptake value (SUVmax) and metabolic tumour volume were measured and correlated with tumour regression grade and survival.
  
  
  RESULTS
  Histopathological tumour response (PR) is a stronger predictor of overall and disease-free survival compared to metabolic response. ∆%SUVmax ≥70% was the only PET metric that predicted PR (82.4% sensitivity, 61.5% specificity, p = 0.047). Histopathological non-responders had a higher risk of death (HR 8.461, p = 0.001) and recurrence (HR 6.385, p = 0.002) and similarly in metabolic non-responders for death (HR 2.956, p = 0.063) and recurrence (HR 3.614, p = 0.028). Ordinalised ∆%SUVmax showed a predictive trend for OS and DFS, but failed to achieve statistical significance.
  
  
  CONCLUSIONS
  PR was a stronger predictor of survival than metabolic response. ∆%SUVmax ≥70% was the best biomarker on PET that predicted PR and survival in oesophageal and gastric adenocarcinoma. Ordinalisation of ∆%SUVmax was not helpful in predicting primary outcomes.
authors.affiliation: University of New South Wales, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: Varun
authors.initials: V
authors.lastname: Manoharan
authors.affiliation: University of Western Sydney, Liverpool Hospital, Sydney, NSW, 2170, Australia.|Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: Soon
authors.initials: S
authors.lastname: Lee
authors.affiliation: University of New South Wales, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: Shanley
authors.initials: S
authors.lastname: Chong
authors.affiliation: Department of Nuclear Medicine and PET, Ground Floor, New Clinical Building, 1 Elizabeth Drive, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: June
authors.initials: J
authors.lastname: Yap
authors.affiliation: Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Coupe
authors.affiliation: University of New South Wales, Liverpool Hospital, Sydney, NSW, 2170, Australia.|Department of Surgery, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Wilson
authors.affiliation: University of Western Sydney, Liverpool Hospital, Sydney, NSW, 2170, Australia.|Department of Surgery, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Merrett
authors.affiliation: University of New South Wales, Liverpool Hospital, Sydney, NSW, 2170, Australia.|Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, 2170, Australia.
authors.forename: Weng
authors.initials: W
authors.lastname: Ng
authors.affiliation: University of New South Wales, Liverpool Hospital, Sydney, NSW, 2170, Australia. michael.lin@swsahs.nsw.gov.au.|University of Western Sydney, Liverpool Hospital, Sydney, NSW, 2170, Australia. michael.lin@swsahs.nsw.gov.au.|Department of Nuclear Medicine and PET, Ground Floor, New Clinical Building, 1 Elizabeth Drive, Liverpool Hospital, Sydney, NSW, 2170, Australia. michael.lin@swsahs.nsw.gov.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Lin
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG; Gastric cancer; Oesophageal cancer; PET; PET-CT; Treatment response