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Confirmation of the prognostic value of pretherapeutic tumor SUR and MTV in patients with esophageal squamous cell carcinoma

  • Frank HofheinzEmail author
  • Yimin Li
  • Ingo G. Steffen
  • Qin Lin
  • Chen Lili
  • Wu Hua
  • Jörg van den Hoff
  • Sebastian Zschaeck
Original Article
  • 63 Downloads

Abstract

Purpose

The prognosis for patients with inoperable esophageal carcinoma is still poor and the reliability of individual therapy outcome prediction based on clinical parameters is not convincing. In a recent publication, we were able to show that PET can provide independent prognostic information in such a patient group and that the tumor-to-blood standard uptake ratio (SUR) can improve the prognostic value of tracer uptake values. The present investigation addresses the question of whether the distinctly improved prognostic value of SUR can be confirmed in a similar patient group that was examined and treated at a different site.

Methods

18F-FDG PET/CT was performed in 147 consecutive patients (115 male, 32 female, mean age: 62 years) with newly diagnosed esophageal squamous cell carcinoma prior to definitive radiochemotherapy. In the PET images, the metabolic active volume (MTV) of the primary tumor was delineated with an adaptive threshold method. For the resulting ROIs, SUVmax and total lesion glycolysis (TLG = MTV × SUVmean) were computed. The blood SUV was determined by manually delineating the aorta in the low-dose CT. SUR values were computed as ratio of tumor SUV and blood SUV. Univariate Cox regression and Kaplan–Meier analysis with respect to overall survival (OS), distant-metastases-free survival (DM), and locoregional control (LRC) was performed. Additionally, a multivariate Cox regression including clinically relevant parameters was performed.

Results

Univariate Cox regression revealed MTV, TLG, and SURmax as significant prognostic factors for OS. MTV as well as TLG were significant prognostic factors for LRC while SURmax showed only a trend for significance. None of the PET parameters was prognostic for DM. In univariate analysis, SUVmax was not prognostic for any of the investigated clinical endpoints. In multivariate analysis (T-stage, N-stage, MTV, and SURmax), MTV was an independent prognostic factor for OS and showed a trend for significance for LRC. SURmax was not an independent predictor for OS or LRC. When including the PET parameters separately in multivariate analysis, MTV as well as SURmax were prognostic factors for OS indicating that SURmax is independent from the clinical parameters but not from MTV. In addition, MTV was an independent prognostic factor for LRC in this separate analysis.

Conclusions

Our study revealed a clearly improved prognostic value of tumor SUR compared to tumor SUV and confirms our previously published findings regarding OS. Furthermore, SUR delivers prognostic information beyond that provided by the clinical parameters alone, but does not add prognostic information beyond that provided by MTV in this patient group. Therefore, our results suggest that pretherapeutic MTV is the parameter of choice for PET-based risk stratification in the considered setting but further investigations are necessary to demonstrate that this suggestion is correct.

Keywords

PET Esophageal cancer Definitive radiochemotherapy SUV SUR 

Notes

Author Contributions

FH and SZ provided ideas for the study. FH, YL, JVDH and SZ performed the analysis and drafted the manuscript. FH and IS designed the figures and calculated the underlying statistics. YL, QL, CL, and WH were responsible for treatment, imaging, collection of patient data, and follow-up. All authors read and approved the final manuscript.

Funding

This work was partly supported by the Major Projects of Fujian Natural Science Foundation (NO. 2008-59-11), the Nature Science Foundation of China (No. 81471684), the Xiamen city science and technology project guidance (3502Z20164009) and the Berliner Krebsgesellschaft (ZSF201720).

Compliance with Ethical Standards

Conflict of interests

None.

Ethical approval

The study was approved by the Institutional Ethics Committees.

Informed Consent

All patients provided signed written informed consent.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Helmholtz-Zentrum Dresden-Rossendorf, PET CenterInstitute of Radiopharmaceutical Cancer ResearchDresdenGermany
  2. 2.Department of Radiation OncologyXiamen Cancer Hospital, The First Affiliated Hospital of Xiamen UniversityXiamenChina
  3. 3.Charite – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear MedicineBerlinGermany
  4. 4.Department of Nuclear MedicineXiamen Cancer Hospital, The First Affiliated Hospital of Xiamen UniversityXiamenChina
  5. 5.Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin, Institute of Health, Department of Radiation OncologyBerlinGermany
  6. 6.Berlin Institute of Health (BIH)BerlinGermany

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