Value of baseline positron emission tomography for predicting overall survival in patient with nonmetastatic esophageal or gastroesophageal junction carcinoma

Abstract

BACKGROUNDThe value of baseline positron emission tomography (PET) for predicting overall survival (OS) or disease‐free survival (DFS) is unclear in patients with nondistant metastatic (locoregional only) esophageal carcinoma. The authors tested the hypothesis that, in this setting, the number of PET abnormalities (NPA) would correlate with OS and DFS.METHODSThe authors of the current study analyzed patients with localized esophageal carcinoma (Stages II and III) who had a baseline PET and endoscopic ultrasonography (EUS) and were all treated with chemoradiotherapy followed by surgery. The standardized uptake value (SUV) of PET avid lesions were evaluated for: SUV of the primary, NPA, peak SUV, and total SUV. Correlations were performed with baseline EUS results, OS, DFS, and clinical and pathologic response.RESULTSForty‐seven patients who underwent chemoradiotherapy followed by surgery were analyzed. Most patients had clinical Stage III cancer. NPA was significantly associated with OS (Cox model, P = 0.02; log‐rank test, P = 0.04) and DFS (P = 0.04). Patients with NPA > 1 had a death hazard ratio of 4.49 (reference, NPA = 1). In a multivariate analysis, NPA was independently predictive of OS (P = 0.03). Alternatively, SUV of the primary tumor, peak SUV, total SUV, and EUS clinical stage did not correlate with the type of response, OS or DFS.CONCLUSIONSData from the current study suggest that for nondistant metastatic esophageal carcinoma, baseline PET can predict patient outcome. Baseline NPA (> 1), reflecting the regional nodal metastases, is an independent predictor of OS. Baseline PET may become a useful stratification factor in randomized trials and for individualizing therapy. Cancer 2005. © 2005 American Cancer Society.

The clinical application of 18F‐fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer

“…The analysis of peak SUV was considered because the max SUV of metastatic lymph nodes has been reported to often be higher than that in primary tumors. 36 It is known that such patients have a poor prognosis. In the current study, the survival of patients having SUVs of metastatic lesions that are higher than those of the primary tumors was extremely poor.…”

“…The degree of FDG uptake in the primary tumor, presenting as the standardized uptake value (SUV), is also associated with patient survival in esophageal cancer. [29][30][31][32][33][34][35][36][37] By contrast, the relation between tumor FDG uptake and patient survival was not found to be statistically significant. 22 We have previously reported a study of 25 patients with resected esophageal SCC that demonstrated a correlation between pretreatment maximum (max) SUV and survival, in addition to diagnostic accuracy for staging.…”

“…To our knowledge, 2 types of reports on the correlation between baseline PET and patient survival have been published to date: those limited to primary tumors 22,[29][30][31][32][33][34] and others that have included both primary tumors and PET-related parameters. [35][36][37] A study by van Westreenen et al reported that the max SUV of the primary tumor was associated with survival on univariate analysis. 29 However, multivariate analysis demonstrated that max SUV did not have a significant additional impact on estimating patient survival.…”

The higher the decrease in the standardized uptake value of positron emission tomography after chemoradiation, the better the survival of patients with gastroesophageal adenocarcinoma

“…[15][16][17][18] However, the initial results and subsequent changes in positron emission tomography (PET) show promise. [19][20][21][22][23][24][25] Many investigators have demonstrated that decrease in metabolic activity as measured by the standardized uptake value (SUV) on PET/computed tomography (CT) as a result of therapy is of prognostic value. [25][26][27][28] In addition, PET/CT images obtained during therapy have been studied in a limited number of patients and seem to provide useful information regarding the response to therapy and prognosis of patients.…”

“…Only PET has been able to provide more discrimination that other clinical staging procedures. 20,21,24,25,27,42 The future of imaging with more specific tracers appears promising. 43 By assessing the uptake of a radioactive glucose analog, PET/CT provides functional information about the cancer, most likely reflecting the biologic behavior of a particular cancer in terms of proliferation, metastatic potential, sensitivity to therapy, and more.…”