Heterogeneity of Glucose Metabolism in Esophageal Cancer Measured by Fractal Analysis of Fluorodeoxyglucose Positron Emission Tomography Image: Correlation between Metabolic Heterogeneity and Survival

Abstract

Background: Intratumoral heterogeneity is a well-recognized characteristic feature of cancer. The purpose of this study is to assess the heterogeneity of the intratumoral glucose metabolism using fractal analysis, and evaluate its prognostic value in patients with esophageal squamous cell carcinoma (ESCC). Methods: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) studies of 79 patients who received curative surgery were evaluated. FDG-PET images were analyzed using fractal analysis software, where differential box-counting method was employed to calculate the fractal dimension (FD) of the tumor lesion. Maximum standardized uptake value (SUVmax) and FD were compared with overall survival (OS). Results: The median SUVmax and FD of ESCCs in this cohort were 13.8 and 1.95, respectively. In univariate analysis performed using Cox's proportional hazard model, T stage and FD showed significant associations with OS (p = 0.04, p < 0.0001, respectively), while SUVmax did not (p = 0.1). In Kaplan-Meier analysis, the low FD tumor (<1.95) showed a significant association with favorable OS (p < 0.0001). In wthe multivariate analysis among TNM staging, serum tumor markers, FD, and SUVmax, the FD was identified as the only independent prognostic factor for OS (p = 0.0006; hazards ratio 0.251, 95% CI 0.104-0.562). Conclusion: Metabolic heterogeneity measured by fractal analysis can be a novel imaging biomarker for survival in patients with ESCC.

Spatial heterogeneity of oxygenation and haemodynamics in breast cancer resolved in vivo by conical multispectral optoacoustic mesoscopy

“…The contrast and variance in our samples correlated negatively with hypoxia but positively with angiogenesis, which can be seen in the sO 2 difference between the tumour centre and rim and in the HbT values at the rim. Measures of heterogeneity such as kurtosis are employed in other imaging modalities, such as X-ray CT 44,50 , PET 39,50 or MRI 41 , for assessing tumour malignancy or staging [51][52][53][54][55][56] , therapeutic response and efficacy 41,57 and survival outcomes [58][59][60][61] . In this study, we employed these metrics for the first time in analysing optical contrast in high resolution, showcasing previously undisclosed optical and sO 2 variability between the tumours studied.…”

Combined 18F-FDG PET/CT Radiomics and Sarcopenia Score in Predicting Relapse-Free Survival and Overall Survival in Patients With Esophagogastric Cancer

“…However, to the best of our knowledge, there is only very limited literature investigating the combination of the imaging features from PET and CT with sarcopenia evaluation. So far, studies correlated the textural features with the stage of the tumor 34,35 or evaluated response prediction, 6,[36][37][38] and only very few studies correlating textural analysis with prognosis are available. For example, Tochigi et al 38 and Dong et al 39 looked at SCC esophageal cancer patients treated with curative surgery.…”

Prognostic Value of [18F]-FDG PET/CT Radiomics Combined with Sarcopenia Status among Patients with Advanced Gastroesophageal Cancer

“…Thus, different and more advanced quantitative measures are needed to capture those underlying aspects of the tumor. In recent years, the field of radiomics, enabling the extraction of high-dimensional data from various sources of medical images, including functional imaging like PET, has shown promising results with regard to response and outcome prediction among a broad range of malignancies, including gastroesophageal cancer [ 36 , 37 , 38 ]. However, to the best of our knowledge, no study so far investigated independent CT and PET features in combination with clinical variables and sarcopenic measurements in a more holistic model for outcome prediction, among patients with advanced, metastatic esophageal and gastroesophageal cancer.…”