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Favorable versus unfavorable prognostic groups by post-chemoradiation FDG-PET imaging in node-positive esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy

  • Wing-Keen Yap
  • Yu-Chuan Chang
  • Chia-Hsun Hsieh
  • Yin-Kai Chao
  • Chien-Cheng Chen
  • Ming-Chieh Shih
  • Tsung-Min Hung
Original Article

Abstract

Purpose

Our purpose was to examine the prognostic value of post-CRT PET based on the presence or absence of FDG-avid metastatic lymph node(s) and metabolic response of the primary tumor in patients with clinically node-positive ESCC treated with definitive chemoradiotherapy (dCRT).

Methods

We identified 108 eligible patients treated by chemoradiotherapy (CRT) with or without resection from our prospectively collected database. Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after initial CRT was defined as the Post-CRT PET favorable group (yPET-F), and otherwise as unfavorable group (yPET-U). The Kaplan-Meier method and Cox regression were performed for survival analyses and multivariable analysis, respectively.

Results

The study cohort was comprised of 59 patients receiving dCRT. Forty-five patients receiving trimodality therapy (TMT) comprised the comparative group and four patients were excluded from further analyses for developing interval distant metastasis detected on post-CRT PET scan. The median follow-up for the study cohort was 41 months. On K-M analysis of the study cohort, yPET-F was found to have significantly better OS (2-year: 72.5% vs 13.7%, p < 0.01) and DMFS (2-year: 71.6% vs 36.6%, p = 0.01) than yPET-U. In multivariable analysis, yPET-F remained as a strong independent favorable prognosticator on both OS (HR 0.08, p < 0.01) and DMFS (HR 0.14, p = 0.02) for the dCRT cohort. Compared with TMT cohort, for yPET-U patients, TMT had better OS (p = 0.03) than dCRT-Operable and dCRT-Operable had superior OS (p = 0.04) than dCRT-Unresectable. For yPET-F patients, there was no difference in both OS (p > 0.99) and DMFS (p = 0.92) between these three groups.

Conclusions

Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after CRT (i.e., yPET-F status) prognosticate for excellent OS and DMFS in cN+ ESCC patients treated with dCRT, and might be comparable to TMT.

Keywords

Fdg-pet Prognosis Escc Chemoradiotherapy Esophageal cancer 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

259_2017_3901_MOESM1_ESM.docx (47 kb)
Supplemental Table 1 (DOCX 47 kb)
259_2017_3901_MOESM2_ESM.docx (83 kb)
Supplemental Table 2 (DOCX 83 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Wing-Keen Yap
    • 1
  • Yu-Chuan Chang
    • 2
    • 3
  • Chia-Hsun Hsieh
    • 4
    • 5
  • Yin-Kai Chao
    • 6
  • Chien-Cheng Chen
    • 7
  • Ming-Chieh Shih
    • 8
  • Tsung-Min Hung
    • 1
  1. 1.Department of Radiation OncologyChang Gung Memorial Hospital-Linkou Medical Center and Chang Gung UniversityTaoyuanTaiwan
  2. 2.Department of Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital-Linkou Medical Center and Chang Gung UniversityTaoyuanTaiwan
  3. 3.Department of Medical Imaging and Radiological Sciences, College of MedicineChang Gung UniversityTaoyuanTaiwan
  4. 4.Circulating Tumor Cell Lab, Division of Medical Oncology, Department of Internal MedicineChang Gung Memorial Hospital-Linkou Medical Center and Chang Gung UniversityTaoyuanTaiwan
  5. 5.Department of Chemical and Materials EngineeringChang Gung UniversityTaoyuanTaiwan
  6. 6.Division of Thoracic Surgery, Department of SurgeryChang Gung Memorial Hospital-Linkou Medical Center and Chang Gung UniversityTaoyuanTaiwan
  7. 7.Department of Diagnostic RadiologyChang Gung Memorial Hospital-Linkou Medical Center and Chang Gung UniversityTaoyuanTaiwan
  8. 8.Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan

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