Prognostic Significance of Pretreatment Staging With 18F-FDG PET in Esophageal Cancer

Abstract

Purpose of the Report Without the routine use of 18 F-FDG PET for initial staging of esophageal cancer, it may lead to inaccurate staging and suboptimal treatment. The purpose of this study was to evaluate the prognostic significance of pretreatment 18 F-FDG PET in nonmetastatic esophageal cancer by comparing the survival between patients with and without pretreatment PET. Materials and Methods We selected newly diagnosed esophageal cancer patients without metastasis between 2009 and 2015 from Taiwan Cancer Registry and National Health Insurance Research Database. Pretreatment 18 F-FDG PET staging was determined according to the implementation of PET within 90 days before starting treatment. Overall survival was calculated from the day of treatment initiation to the death from any cause. Survival curves were compared between patients with and without PET staging using the log-rank test. Results Of the 9078 patients included, 1765 (19.4%) and 7313 (80.6%) patients were staged with and without pretreatment PET, respectively. The median follow-up time for all patients and survivors was 1.29 years and 5.46 years, respectively. The pretreatment PET group had a lower risk of death than the no pretreatment PET group (hazards ratio, 0.74; 95% confidence interval, 0.70–0.79; P < 0.001). After adjusting for age, stage, histology, and tumor location, pretreatment PET remained significantly correlated with a lower risk of death (hazards ratio, 0.78; 95% confidence interval, 0.73–0.83; P < 0.001). Conclusions The utilization of pretreatment 18 F-FDG PET for staging in nonmetastatic esophageal malignancy is associated with a lower risk of death even after adjusting for age, stage, histology, and tumor location.

Pre-CCRT 18-fluorodeoxyglucose PET-CT improves survival in patients with advanced stages p16-negative oropharyngeal squamous cell carcinoma via accurate radiation treatment planning

“…Routine use of pretreatment PET-CT might be unnecessary for each patient with OPSCC receiving CCRT. The present study indicated the survival benefit of pre-CCRT PET-CT in the patients with nonmetastatic p16-negative OPSCC receiving CCRT; this finding is similar to that of a previous study reporting improved survival in patients with nonmetastatic esophageal malignancy after pretreatment 18 F-FDG PET [34]. The results of our study can be used to develop future health policies and health insurance payment standards in terms Compared with the control group, more patients in the case group had advanced AJCC stages, advanced cN stages, and poor differentiation, which were identified as poor prognostic factors for OS.…”

“…However, few studies have evaluated whether pretreatment PET-CT is associated with improved survival in OPSCC. A recent study reported that the utilization of pretreatment 18 F-FDG PET for the staging of nonmetastatic esophageal malignancy was associated with a lower risk of death, even after adjustment for age, stage, histology, and tumor location [34]. Routine use of pretreatment PET-CT might be unnecessary for each patient with OPSCC receiving CCRT.…”

Prognostic Value of 18F-FDG PET/CT Volume-Based Metabolic Parameters in Patients with Node-Negative Stage II Esophageal Squamous Cell Carcinoma

“…Esophageal cancer is the eighth common cancer worldwide [1] and the fifth prevalent cancer in Taiwan [2]. ESCC and esophageal adenocarcinoma (EAC) are the two major histopathological subtypes of esophageal cancer.…”

“…However, largely based on tumor size and anatomy, the TNM staging system lacks tumor metabolic information and, unavoidably, contains major prognostic discrepancy when comparing patients with small-sized, metabolically aggressive tumors to patients with large-sized, metabolically indolent tumors. Despite recent medical advances, according to the nationwide population-based study of Taiwan, the five-year overall survival for stage II esophageal cancer was only about 28% [2]. Information in reliable prognostic and predictive factors is urgently needed in early, non-metastatic esophageal cancer.…”