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Hui WK, Charaf Z, Hendriks JMH, Van Schil PE. True Prevalence of Unforeseen N2 Disease in NSCLC: A Systematic Review + Meta-Analysis. Cancers (Basel) 2023; 15:3475. [PMID: 37444585 DOI: 10.3390/cancers15133475] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67-9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31-58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored.
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Affiliation(s)
- Wing Kea Hui
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Zohra Charaf
- Department of Cardiothoracic Surgery, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
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Xia L, Li X, Zhu J, Gao Z, Zhang J, Yang G, Wang Z. Prognostic value of baseline 18F-FDG PET/CT in patients with esophageal squamous cell carcinoma treated with definitive (chemo)radiotherapy. Radiat Oncol 2023; 18:41. [PMID: 36829219 PMCID: PMC9960216 DOI: 10.1186/s13014-023-02224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
PURPOSE To investigate the prognostic value of baseline 18F-FDG PET/CT in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive (chemo)radiotherapy. METHODS A total of 98 ESCC patients with cTNM stage T1-4, N1-3, M0 who received definitive (chemo)radiotherapy after 18F-FDG PET/CT examination from December 2013 to December 2020 were retrospectively analyzed. Clinical factors included age, sex, histologic differentiation grade, tumor location, clinical stage, and treatment strategies. Parameters obtained by 18F-FDG PET/CT included SUVmax of primary tumor (SUVTumor), metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUVmax of lymph node (SUVLN), PET positive lymph nodes (PLNS) number, the shortest distance between the farthest PET positive lymph node and the primary tumor in three-dimensional space after the standardization of the patient BSA (SDmax(LN-T)). Univariate and multivariate analysis was conducted by Cox proportional hazard model to explore the significant factors affecting overall survival (OS) and progression-free survival (PFS) in ESCC patients. RESULTS Univariate analysis showed that tumor location, SUVTumor, MTV, TLG, PLNS number, SDmax (LN-T) were significant predictors of OS and tumor location, and clinical T stage, SUVTumor, MTV, TLG, SDmax (LN-T) were significant predictors of PFS (all p < 0.1). Multivariate analysis showed that MTV and SDmax (LN-T) were independent prognostic factors for OS (HR = 1.018, 95% CI 1.006-1.031; p = 0.005; HR = 6.988, 95% CI 2.119-23.042; p = 0.001) and PFS (HR = 1.019, 95% CI 1.005-1.034; p = 0.009; HR = 5.819, 95% CI 1.921-17.628; p = 0.002). Combined with independent prognostic factors MTV and SDmax (LN-T), we can further stratify patient risk. CONCLUSIONS Before treatment, 18F-FDG PET/CT has important prognostic value for patients with ESCC treated with definitive (chemo)radiotherapy. The lower the value of MTV and SDmax (LN-T), the better the prognosis of patients.
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Affiliation(s)
- Lianshuang Xia
- grid.412521.10000 0004 1769 1119Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong China
| | - Xiaoxu Li
- grid.412521.10000 0004 1769 1119Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong China
| | - Jie Zhu
- grid.412521.10000 0004 1769 1119Department of Scientific Research Management and Foreign Affairs, The Affiliated Hospital of Qingdao University, Qingdao, Shandong China
| | - Zhaisong Gao
- grid.412521.10000 0004 1769 1119Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong China
| | - Ju Zhang
- grid.412521.10000 0004 1769 1119Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong China
| | - Guangjie Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Wrenn SM, Moore AL, Shah HJ, Barletta JA, Vaidya A, Kilbridge KL, Doherty GM, Jacene HA, Nehs MA. Higher SUV max on FDG-PET is associated with shorter survival in adrenocortical carcinoma. Am J Surg 2023; 225:309-314. [PMID: 36137821 DOI: 10.1016/j.amjsurg.2022.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/29/2022] [Accepted: 08/27/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is an aggressive, rare malignancy. 2-deoxy-2-[18F]-fluoro-d-glucose positron emission tomography (FDG-PET) assesses tumor metabolism and glucose utilization. We hypothesized that higher maximum standard uptake value (SUVmax) is associated with decreased survival. METHODS We performed a retrospective analysis of patients with ACC. Included patients (n = 26) had an FDG-PET scan available with a documentable SUVmax. Patients were dichotomized into "High" (≥8.4, n = 12) and "Low" (<8.4, n = 14) SUVmax. Univariate analysis and survival analysis were performed to compare groups. RESULTS Demographics between groups were equivalent. The high SUVmax cohort demonstrated lower survival (median 479 days or 15.7 months) compared to the low group (median 1490 days or 48.6 months, p = .01). Log-Rank curve confirmed differences in survival (p = .007). CONCLUSIONS Higher SUVmax was associated with significantly worse survival in ACC and may reflect a more aggressive phenotype. FDG-PET may provide clinically useful information to determine prognosis and treatment. Further studies should prospectively evaluate using FDG-PET/CT in ACC.
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Affiliation(s)
- Sean M Wrenn
- .Brigham and Women's Hospital, Boston, MA, USA; .Rush University Medical Center, Chicago, IL, USA
| | | | - Hina J Shah
- .Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Kerry L Kilbridge
- .Brigham and Women's Hospital, Boston, MA, USA; .Dana-Farber Cancer Institute Lank Center for Genitourinary Oncology, USA.
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Prexler C, Knape MS, Erlewein-Schweizer J, Roll W, Specht K, Woertler K, Weichert W, von Luettichau I, Rossig C, Hauer J, Richter GHS, Weber W, Burdach S. Correlation of Transcriptomics and FDG-PET SUVmax Indicates Reciprocal Expression of Stemness-Related Transcription Factor and Neuropeptide Signaling Pathways in Glucose Metabolism of Ewing Sarcoma. Cancers (Basel) 2022; 14:cancers14235999. [PMID: 36497479 PMCID: PMC9735504 DOI: 10.3390/cancers14235999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In Ewing sarcoma (EwS), long-term treatment effects and poor survival rates for relapsed or metastatic cases require individualization of therapy and the discovery of new treatment methods. Tumor glucose metabolic activity varies significantly between patients, and FDG-PET signals have been proposed as prognostic factors. However, the biological basis for the generally elevated but variable glucose metabolism in EwS is not well understood. METHODS We retrospectively included 19 EwS samples (17 patients). Affymetrix gene expression was correlated with maximal standardized uptake value (SUVmax) using machine learning, linear regression modelling, and gene set enrichment analyses for functional annotation. RESULTS Expression of five genes correlated (MYBL2, ELOVL2, NETO2) or anticorrelated (FAXDC2, PLSCR4) significantly with SUVmax (adjusted p-value ≤ 0.05). Additionally, we identified 23 genes with large SUVmax effect size, which were significantly enriched for "neuropeptide Y receptor activity (GO:0004983)" (adjusted p-value = 0.0007). The expression of the members of this signaling pathway (NPY, NPY1R, NPY5R) anticorrelated with SUVmax. In contrast, three transcription factors associated with maintaining stemness displayed enrichment of their target genes with higher SUVmax: RNF2, E2F family, and TCF3. CONCLUSION Our large-scale analysis examined comprehensively the correlations between transcriptomics and tumor glucose utilization. Based on our findings, we hypothesize that stemness may be associated with increased glucose uptake, whereas neuroectodermal differentiation may anticorrelate with glucose uptake.
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Affiliation(s)
- Carolin Prexler
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
| | - Marie Sophie Knape
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
| | | | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Munster, Germany
| | - Katja Specht
- Institute of Pathology, Technische Universität München, 81675 Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technische Universität München, 81675 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
- ERN PaedCan, 1090 Vienna, Austria
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Muenster, 48149 Muenster, Germany
- Cells-in-Motion Cluster of Excellence (EXC 1003-CiM), University of Muenster, 48149 Muenster, Germany
| | - Julia Hauer
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
| | - Guenther H. S. Richter
- Department of Pediatrics, Division of Oncology and Hematology, Charite–Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, 13353 Berlin, Germany
| | - Wolfgang Weber
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
- Institute of Pathology, Technische Universität München, 81675 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- Academy of Translational Medicine and Department of Molecular Oncology–British Columbia Cancer Research Centre, University of British Columbia, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada
- Correspondence:
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Lee H, Lee KS, Min YW, Kim HK, Zo JI, Shim YM, Choi JY. Prognostic Significance of FDG PET/CT in Esophageal Squamous Cell Carcinoma in the Era of the 8th AJCC/UICC Staging System. Front Oncol 2022; 12:861867. [PMID: 35847839 PMCID: PMC9280981 DOI: 10.3389/fonc.2022.861867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Recently, the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system was updated for its 8th edition. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a useful imaging tool to diagnose and predict prognoses for esophageal cancer. However, there was no previous study to explore the role of FDG PET/CT in the staging system based on the 8th edition. The prognostic value of FDG PET/CT was investigated in patients with esophageal squamous cell carcinoma (SqCC) considering the new 8th AJCC/UICC staging system. Methods Subjects were 721 patients with esophageal SqCC undergoing pretherapeutic FDG PET/CT. Clinico-pathological variables and the maximum standardized uptake value (SUVmax) of the primary tumor were included in survival analysis. Subgroup analysis was performed to compare hazard ratios according to pathological stage and SUVmax. A new staging classification including FDG uptake was proposed. Results In multivariate survival analysis, pathological stage and SUVmax of the primary tumor were selected as independent prognostic factors for overall survival in both the 7th and 8th editions. The proposed new staging system showed better discrimination for overall survival between stage I and II than did the conventional staging system (hazard ratios: 2.250 vs. 1.341). Conclusions The FDG uptake of the primary tumor was found to be an independent prognostic factor along with pathological stage based on both 7th and 8th AJCC/UICC staging systems in patients with esophageal SqCC. The suggested new staging system including SUVmax was better for predicting prognoses than the conventional staging system.
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Affiliation(s)
- Hyunjong Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang Won Min
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Joon Young Choi,
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6
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Lee H, Lee KS, Min YW, Kim HK, Zo JI, Shim YM, Choi JY. Prognostic Significance of FDG PET/CT in Esophageal Squamous Cell Carcinoma in the Era of the 8th AJCC/UICC Staging System. Front Oncol 2022; 12:861867. [PMID: 35847839 DOI: 10.3389/fonc.2022.861867.org.10.3389/fonc.2022.861867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/31/2022] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Recently, the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system was updated for its 8th edition. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a useful imaging tool to diagnose and predict prognoses for esophageal cancer. However, there was no previous study to explore the role of FDG PET/CT in the staging system based on the 8th edition. The prognostic value of FDG PET/CT was investigated in patients with esophageal squamous cell carcinoma (SqCC) considering the new 8th AJCC/UICC staging system. METHODS Subjects were 721 patients with esophageal SqCC undergoing pretherapeutic FDG PET/CT. Clinico-pathological variables and the maximum standardized uptake value (SUVmax) of the primary tumor were included in survival analysis. Subgroup analysis was performed to compare hazard ratios according to pathological stage and SUVmax. A new staging classification including FDG uptake was proposed. RESULTS In multivariate survival analysis, pathological stage and SUVmax of the primary tumor were selected as independent prognostic factors for overall survival in both the 7th and 8th editions. The proposed new staging system showed better discrimination for overall survival between stage I and II than did the conventional staging system (hazard ratios: 2.250 vs. 1.341). CONCLUSIONS The FDG uptake of the primary tumor was found to be an independent prognostic factor along with pathological stage based on both 7th and 8th AJCC/UICC staging systems in patients with esophageal SqCC. The suggested new staging system including SUVmax was better for predicting prognoses than the conventional staging system.
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Affiliation(s)
- Hyunjong Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang Won Min
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Prognostic Value of 18F-FDG PET/CT Volume-Based Metabolic Parameters in Patients with Node-Negative Stage II Esophageal Squamous Cell Carcinoma. Metabolites 2021; 12:metabo12010007. [PMID: 35050129 PMCID: PMC8781087 DOI: 10.3390/metabo12010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/02/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is a major cancer prevalent in Asian males. Pretreatment tumor burden can be prognostic for ESCC. We studied the prognostic value of metabolic parameters of 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and the serum squamous cell carcinoma antigen (SCC-Ag) level in node-negative stage II ESCC patients. Eighteen males underwent staging evaluation were included. The volume-based metabolic parameters derived from 18F-FDG PET/CT, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were obtained using the PET Volume Computer Assisted Reading application. The Spearman correlation coefficients were calculated to assess the relationship between metabolic parameters and pretreatment serum SCC-Ag levels. Based on the 5-year follow-up, patients were sub-divided into the demised and the stable groups. Potential prognostic value was assessed by independent t-test and the Mann–Whitney U test. The association of overall survival was assessed using univariate and multivariate Cox regression analyses. The demised group showed significant higher values in serum SCC-Ag, as well as in MTV and TLG, but not SUVmax and SUVmean. The SUVmax, MTV, TLG, and serum SCC-Ag showed significant association with overall survival. Our findings suggest potential usage of pretreatment volume-based metabolic parameters of 18F-FDG PET/CT and serum SCC-Ag as prognostic factors for node-negative stage II ESCC patients.
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The relationship between FDG PET/CT-defined metabolic parameters and the histopathological subtype of oesophageal carcinomas. Pol J Radiol 2020; 85:e254-e260. [PMID: 32612724 PMCID: PMC7315051 DOI: 10.5114/pjr.2020.95945] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 04/20/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) combined with computed tomography (CT) scan is accepted as a standard tool in the staging of oesophageal cancer (OC). Histological subtype of tumour is known to be a major determinant of prognosis and metabolic behaviour. In this study, we aimed to evaluate the effect of histological subtypes of OC on standard uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) obtained by PET/CT, and also to compare this effect with prognosis. Material and methods Images and clinical course data of 57 patients who were diagnosed with EC and treated in our hospital between 2009 and 2016 were evaluated in a retrospective manner. PET/CT images were re-analysed in terms of metabolic parameters, and observations were compared with histological subtypes. Results No significant difference was observed between histological subtypes with SUVmax, overall survival (OS), or progression-free survival (PFS). Thus, MTV was observed to be related with histological subtype; MTV values of adenocancer patients were significantly higher than those of squamous cell cancer patients. Conclusions Metabolic tumour volume was related with histological subtype of OC, but clinical staging, TLG, and SUVmax values were not related with histological subtype, which may suggest the use of MTV as a routine parameter for OC and inclusion of MTV observations in prognostic scoring.
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Barnes CA, Aldakkak M, Clarke CN, Christians KK, Bucklan D, Holt M, Tolat P, Ritch PS, George B, Hall WA, Erickson BA, Evans DB, Tsai S. Value of Pretreatment 18F-fluorodeoxyglucose Positron Emission Tomography in Patients With Localized Pancreatic Cancer Treated With Neoadjuvant Therapy. Front Oncol 2020; 10:500. [PMID: 32363161 PMCID: PMC7180175 DOI: 10.3389/fonc.2020.00500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background:18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging is not routine in patients with localized pancreatic cancer (PC). We evaluated the prognostic value of PET/CT in patients who received neoadjuvant therapy. Methods: Patients with localized PC underwent pretreatment PET/CT with or without posttreatment (preop) PET/CT. Maximum standardized uptake values (SUV) were classified as high or low based on a cut point of 7.5 at diagnosis (SUVdx) and 3.5 after neoadjuvant therapy (preoperative; SUVpreop). Preop carbohydrate antigen 19-9 (CA19-9) was classified as normal ( ≤ 35 U/mL) or elevated. Results: Pretreatment PET/CT imaging was performed on 201 consecutive patients; SUVdx was high in 98 (49%) and low in 103 (51%). Preop PET/CT was available in 104 (52%) of the 201 patients; SUVpreop was high in 60 (58%) and low in 44 (42%). Following neoadjuvant therapy, preop CA19-9 was normal in 90 (45%) patients and elevated in 111 (55%). Median overall survival (OS) of all patients was 27 months; 33 months for the 103 patients with a low SUVdx and 22 months for the 98 patients with a high SUVdx (p = 0.03). Median OS for patients with low SUVdx/normal preop CA19-9, high SUVdx/normal preop CA19-9, low SUVdx/elevated preop CA19-9, and high SUVdx/elevated preop CA19-9 were 66, 34, 23, and 17 months, respectively (p < 0.0001). OS was 44 months for the 148 (74%) patients who completed all intended neoadjuvant therapy and surgery and 13 months for the 53 (26%) who did not undergo surgery (p < 0.001). Conclusion: Pretreatment PET/CT avidity and preop CA19-9 are clinically significant prognostic markers in patients with PC.
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Affiliation(s)
- Chad A Barnes
- LaBahn Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mohammed Aldakkak
- LaBahn Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Callisia N Clarke
- LaBahn Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kathleen K Christians
- LaBahn Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Daniel Bucklan
- Department of Radiology, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michael Holt
- Department of Radiology, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Parag Tolat
- Department of Radiology, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Paul S Ritch
- Department of Medicine, Division of Hematology and Oncology, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ben George
- Department of Medicine, Division of Hematology and Oncology, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - William A Hall
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Beth A Erickson
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Douglas B Evans
- LaBahn Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Susan Tsai
- LaBahn Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States
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Belge G, Bilgin C, Ozkaya G, Kandemirli SG, Alper E. Prognostic value of pretreatment tumor-to-blood standardized uptake ratio (SUR) in rectal cancer. Ann Nucl Med 2020; 34:432-440. [PMID: 32297136 DOI: 10.1007/s12149-020-01465-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The prognostic value of SUV on pretreatment F-18 FDG PET/CT imaging in patients with rectal cancer is a matter of debate. SUR is of prognostic value for survival in different cancers. In this study, we aimed to examine the potential prognostic value of SUR and other parameters in pretreatment F-18 FDG PET/CT for non-metastatic rectal cancer. METHODS One hundred four non-metastatic rectal cancer patients who underwent pretreatment PET/CT between March 2012 and January 2018 were included in the study. Firstly, SUVmax, SUVmean, MTV, and TLG were calculated semi-automatically at the workstation. SUR was calculated as the ratio of tumor SUVmax to thoracic aorta blood SUVmean. Univariate Cox regression and Kaplan-Meier analysis were used to evaluate overall survival (OS), progression free survival (PFS), and local recurrence (LR). Then, multivariate Cox regression analysis, which included the parameters that were significant in the univariate analysis, was performed. RESULTS Multivariate Cox regression analysis revealed that SUR was a prognostic factor for PFS. Age and T stage were prognostic factors for both OS and PFS. MTV was found to be independent risk factors for OS. CONCLUSIONS In our study, SUR was the only F-18 FDG PET/CT parameter found to be significant for PFS. The development of new parameters can increase the prognostic value of F-18 FDG PET/CT.
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Affiliation(s)
- Gokce Belge
- Department of Nuclear Medicine, Uludag University School of Medicine, 16059, Bursa, Turkey.
| | - Cem Bilgin
- Department of Radiology, Uludag University School of Medicine, Bursa, Turkey
| | - Guven Ozkaya
- Department of Statistics, Uludag University School of Medicine, Bursa, Turkey
| | | | - Eray Alper
- Department of Nuclear Medicine, Uludag University School of Medicine, 16059, Bursa, Turkey
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11
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Arslan E, Aksoy T, Gündoğan C, Şen Ç, Yılmaz Tatar S, Dursun N, Çermik TF. Metabolic Characteristics and Diagnostic Contribution of 18F-FDG PET/CT in Gastric Carcinomas. Mol Imaging Radionucl Ther 2020; 29:25-32. [PMID: 32079385 PMCID: PMC7057726 DOI: 10.4274/mirt.galenos.2020.75537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: The aim of this study was to evaluate 18F-fluoro-2-deoxy-glucose (FDG) uptake patterns in primary tumors and metastatic lesions, and also to assess the diagnostic contribution of positron emission tomography/computed tomography (PET/CT) in the initial staging of gastric cancer (GC). Methods: The total number of 341 patients with GC were included in this study. All 18F-FDG PET/CT imagings were performed for initial staging. The maximum standardized uptake value (SUVmax) of primary tumor, obtained from 18F-FDG PET/CT imaging was compared between subtypes of GC. Results: Mean SUVmax of 339 patients’ primary tumor was 12.9±8.6. The highest mean SUVmax was detected in patients with medullary subtype GC (17.8±9.9) while the lowest mean SUVmax (9.7±7.6) was seen in signet ring cell carcinoma (SRCC). The primary mean SUVmax was found statistically higher in tubular adenocarcinoma (TAC) group than SRCC group (p<0.001). Higher SUVmax values were found statistically significantly correlated with advanced age (aged ≥60) and increased tumor size (>3 cm) in patients with TAC (p=0.03). Primary tumor SUVmax was found statistically higher in regional lymph node (RLN) positive patients than in RLN negative patients in TAC and SRCC groups (p<0.001 and p=0.012, respectivelly). Also, in patients with SRCC, SUVmax was significantly higher in the distant metastatic group than in the group without metastasis (p=0.025). Conclusion: Increased primary tumor SUVmax was associated with some of clinical parameters such as age and RLN metastasis in patients with TAC. However, there was no relationship between distant metastatic state and primary tumor 18F-FDG uptake in TAC. However, high SUVmax of primary tumor in SRCC was associated with regional and distant metastasis, and primary tumor 18F-FDG uptake may be a prognostic value for this subgroup.
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Affiliation(s)
- Esra Arslan
- University of Health and Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tamer Aksoy
- University of Health and Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Cihan Gündoğan
- University of Health and Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Çiğdem Şen
- University of Health and Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Selda Yılmaz Tatar
- Yeniyüzyıl University, Gaziosmanpaşa Hospital, Department of Nuclear Medicine, İstanbul, Turkey
| | - Nevra Dursun
- University of Health and Sciences, İstanbul Training and Research Hospital, Department of Pathology, İstanbul, Turkey
| | - Tevfik Fikret Çermik
- University of Health and Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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12
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Mantziari S, Pomoni A, Prior JO, Winiker M, Allemann P, Demartines N, Schäfer M. 18F- FDG PET/CT-derived parameters predict clinical stage and prognosis of esophageal cancer. BMC Med Imaging 2020; 20:7. [PMID: 31969127 PMCID: PMC6977262 DOI: 10.1186/s12880-019-0401-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although 18F- FDG PET/CT is validated in baseline workup of esophageal cancer to detect distant metastases, it remains underused in assessing local staging and biology of the primary tumor. This study aimed to evaluate the association between 18F- FDG PET/CT-derived parameters of esophageal cancer, and its clinico-pathological features and prognosis. METHODS All patients (n = 86) with esophageal adenocarcinoma or squamous cell cancer operated between 2005 and 2014 were analyzed. Linear regression was used to identify clinico-pathologic features of esophageal cancer associated with the tumor's maximal Standardized Uptake Value (SUVmax), Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV). ROC curve analysis was performed to precise the optimal cutoff of each variable associated with a locally advanced (cT3/4) status, long-term survival and recurrence. Kaplan Meier curves and Cox regression were used for survival analyses. RESULTS High baseline SUVmax was associated with cT3/4 status and middle-third tumor location, TLG with a cT3/4 and cN+ status, whereas MTV only with active smoking. A cT3/4 status was significantly predicted by a SUVmax > 8.25 g/mL (p < 0.001), TLG > 41.7 (p < 0.001) and MTV > 10.70 cm3 (p < 0.01) whereas a SUVmax > 12.7 g/mL was associated with an early tumor recurrence and a poor disease-free survival (median 13 versus 56 months, p = 0.030), particularly in squamous cell cancer. CONCLUSIONS Baseline 18F- FDG PET/CT has a high predictive value of preoperative cT stage, as its parameters SUVmax, TLG and MTV can predict a locally advanced tumor with high accuracy. A SUVmax > 12.7 g/mL may herald early tumor recurrence and poor disease-free survival.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anastasia Pomoni
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - John O Prior
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Michael Winiker
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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13
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Yang CK, Yeh JCY, Yu WH, Chien LI, Lin KH, Huang WS, Hsu PK. Deep Convolutional Neural Network-Based Positron Emission Tomography Analysis Predicts Esophageal Cancer Outcome. J Clin Med 2019; 8:jcm8060844. [PMID: 31200519 PMCID: PMC6616908 DOI: 10.3390/jcm8060844] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
In esophageal cancer, few prediction tools can be confidently used in current clinical practice. We developed a deep convolutional neural network (CNN) with 798 positron emission tomography (PET) scans of esophageal squamous cell carcinoma and 309 PET scans of stage I lung cancer. In the first stage, we pretrained a 3D-CNN with all PET scans for a task to classify the scans into esophageal cancer or lung cancer. Overall, 548 of 798 PET scans of esophageal cancer patients were included in the second stage with an aim to classify patients who expired within or survived more than one year after diagnosis. The area under the receiver operating characteristic curve (AUC) was used to evaluate model performance. In the pretrain model, the deep CNN attained an AUC of 0.738 in identifying patients who expired within one year after diagnosis. In the survival analysis, patients who were predicted to be expired but were alive at one year after diagnosis had a 5-year survival rate of 32.6%, which was significantly worse than the 5-year survival rate of the patients who were predicted to survive and were alive at one year after diagnosis (50.5%, p < 0.001). These results suggest that the prediction model could identify tumors with more aggressive behavior. In the multivariable analysis, the prediction result remained an independent prognostic factor (hazard ratio: 2.830; 95% confidence interval: 2.252–3.555, p < 0.001). We conclude that a 3D-CNN can be trained with PET image datasets to predict esophageal cancer outcome with acceptable accuracy.
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Affiliation(s)
| | | | | | - Ling-I Chien
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Ko-Han Lin
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Wen-Sheng Huang
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
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15
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Can the Efficacy of [ 18F]FDG-PET/CT in Clinical Oncology Be Enhanced by Screening Biomolecular Profiles? Pharmaceuticals (Basel) 2019; 12:ph12010016. [PMID: 30678034 PMCID: PMC6469153 DOI: 10.3390/ph12010016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/03/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022] Open
Abstract
Positron Emission Tomography (PET) is a functional imaging modality widely used in clinical oncology. Over the years the sensitivity and specificity of PET has improved with the advent of specific radiotracers, increased technical accuracy of PET scanners and incremental experience of Radiologists. However, significant limitations exist—most notably false positives and false negatives. Additionally, the accuracy of PET varies between cancer types and in some cancers, is no longer considered a standard imaging modality. This review considers the relative influence of macroscopic tumour features such as size and morphology on 2-Deoxy-2-[18F]fluoroglucose ([18F]FDG) uptake by tumours which, though well described in the literature, lacks a comprehensive assessment of biomolecular features which may influence [18F]FDG uptake. The review aims to discuss the potential influence of individual molecular markers of glucose transport, glycolysis, hypoxia and angiogenesis in addition to the relationships between these key cellular processes and their influence on [18F]FDG uptake. Finally, the potential role for biomolecular profiling of individual tumours to predict positivity on PET imaging is discussed to enhance accuracy and clinical utility.
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16
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Shimizu D, Yuasa N, Miyake H, Takeuchi E, Miyata K, Itoh S. Clinical significance of SUVmax on preoperative 18F-fluorodeoxyglucose positron emission tomography in patients who underwent R0-esophagectomy for esophageal cancer. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:401-409. [PMID: 30214089 PMCID: PMC6125650 DOI: 10.18999/nagjms.80.3.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The standardized uptake value (SUV) is a marker of tumor glucose metabolism, detected using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and may reflect tumor aggressiveness. The purpose of this study was to evaluate the clinical significance of maximum SUV (SUVmax) of primary esophageal cancer (EC) lesions. A total of 86 patients with EC who underwent pre-treatment FDG-PET and R0-resection were included in our study. The mean patient age was 65 years, and 87% were men. Histologically, cancers included squamous cell carcinomas, adenocarcinomas, and other tumors in 72, 3, and 11 patients, respectively. Preoperative chemotherapy with or without radiotherapy was performed in 4 and 37 patients, respectively. Measured patient outcomes included the correlation between the SUVmax of the primary EC lesion and clinicopathological factors in patients who did not undergo preoperative treatment (n = 45), and the investigation of relapse-free survival (RFS) according to SUVmax and the relationship between SUVmax and recurrence sites in all patients (n=86). The mean SUVmax was 8.9 ± 4.6, and SUVmax values significantly correlated with tumor invasion depth and stage. The 5-year RFS for the enrolled patients was 57%, and the RFS of patients with SUVmax < 7.0 was better than that of patients with SUVmax ≥ 7.0, with a marginal difference (p = 0.0892). Lymph node recurrences were significantly more common in patients with SUVmax ≥ 7.0, compared to patients with SUVmax < 7.0. Therefore, the SUVmax value of the primary EC lesion before preoperative treatment may be predictive of RFS and lymph node recurrence.
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Affiliation(s)
- Daisuke Shimizu
- Department of Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Norihiro Yuasa
- Department of Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Hideo Miyake
- Department of Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Eiji Takeuchi
- Department of Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Kanji Miyata
- Department of Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Shigeki Itoh
- Department of Diagnostic Radiology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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17
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Dong Y, Wei Y, Chen G, Huang Y, Song P, Liu S, Zheng J, Cheng M, Yuan S. Relationship Between Clinicopathological Characteristics and PET/CT Uptake in Esophageal Squamous Cell Carcinoma: [18F]Alfatide versus [18F]FDG. Mol Imaging Biol 2018; 21:175-182. [DOI: 10.1007/s11307-018-1216-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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18
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Goel R, Subramaniam RM, Wachsmann JW. PET/Computed Tomography Scanning and Precision Medicine: Esophageal Cancer. PET Clin 2017; 12:373-391. [PMID: 28867110 DOI: 10.1016/j.cpet.2017.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal cancer commonly has a poor prognosis, which requires an accurate diagnosis and early treatment to improve outcome. Other modalities for staging, such as endoscopic ultrasound imaging and computed tomography (CT) scans, have a role in diagnosis and staging. However, PET with fluorine-18 fluoro-2-deoxy-d-glucose/CT (FDG PET/CT) scanning allows for improved detection of distant metastatic disease and can help to prevent unnecessary interventions that would increase morbidity. FDG PET/CT scanning is valuable in the neoadjuvant chemotherapy assessment and predicting survival outcomes subsequent to surgery. FDG PET/CT scanning detects recurrent disease and metastases in follow-up.
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Affiliation(s)
- Reema Goel
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Rathan M Subramaniam
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Clinical Sciences, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Biomedical Engineering, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Jason W Wachsmann
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA.
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19
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Sugimura K, Miyata H, Yano M, Yanagimoto Y, Ho MJ, Kobayashi S, Takahashi H, Omori T, Ohue M, Sakon M. Is 18F-FDG-PET useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma? Gen Thorac Cardiovasc Surg 2017; 65:455-462. [PMID: 28585161 DOI: 10.1007/s11748-017-0786-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Induction therapy followed by surgery is a promising strategy for esophageal cancer patients with invasion of the trachea/bronchus or aorta. However, no diagnostic criteria have been established to diagnose whether R0 resection can be performed. We investigated whether 18F-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) and other modalities are useful for predicting R0 resection. METHODS Fifty-seven patients with esophageal cancer invading the trachea/bronchus or aorta who underwent induction therapy followed by surgery were enrolled. We divided the participants into two groups, an R0 resection group (n = 43) and a non-R0 resection group (n = 14), and then compared the between-group results of three modalities, including computed tomography (CT), endoscopy and 18F-FDG-PET, before and after induction therapy. RESULTS The post-maximal standardized uptake value (SUVmax) after induction therapy in the R0 resection group was significantly lower than that in the non-R0 resection group (4.4 vs. 6.6, p = 0.005). The receiver operating characteristic curve analysis showed that the cut-off value for the post-SUVmax based on 18F-FDG-PET prediction of R0 resection was 4.7. Furthermore, a tumor reduction rate of ≥44% on CT, no residual stenosis, and no deep ulcer on endoscopy were associated with R0 resection after induction therapy (p = 0.002, p = 0.091, and p = 0.059, respectively). Multivariate logistic analyses revealed that the tumor reduction rate on CT and post-SUVmax <4.7 in 18F-FDG-PET were independent factors for R0 resection. CONCLUSIONS The post-SUVmax determined by 18F-FDG-PET and the volume reduction rate based on CT scans were useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma.
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Affiliation(s)
- Keijiro Sugimura
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Yoshitomo Yanagimoto
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Moon Jeong Ho
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Shogo Kobayashi
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Hidenori Takahashi
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Takeshi Omori
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Masayuki Ohue
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Masato Sakon
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
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20
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Prognostic value of pretreatment standardized uptake value of F-18-fluorodeoxyglucose PET in patients with gastric cancer: a meta-analysis. BMC Cancer 2017; 17:275. [PMID: 28415990 PMCID: PMC5392988 DOI: 10.1186/s12885-017-3271-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/07/2017] [Indexed: 12/22/2022] Open
Abstract
Background F-18- fluorodeoxyglucose Positron emission tomography (18FDG-PET) has been widely used in clinical practice. However, the prognostic value of the pretreatment standardized uptake value (SUV) for patients with gastric cancer remains controversial. Methods Major databases were systematically searched. The quality of the included studies was assessed using the Newcastle–Ottawa scale; the PET protocols were also evaluated. The pooled hazard ratio (HR) for overall survival (OS) and recurrence-free survival (RFS) were used to estimate the effect size. Data from the included studies were analyzed using Review Manager Software version 5.2. Results Eight studies with 1080 patients were included. The pooled HR for OS of six studies including 672 patients was 1.72 (95% CI [1.28–2.3], p = 0.0004, I2 = 0%), indicating that patients with high SUVs may have poor prognosis. The pooled HR for RFS was 1.70 (95% CI [1.20–2.39], p = 0.003, I2 = 0%). Subgroup analysis based on the cutoff values determining method indicated that the receiver operating characteristic (ROC) method could better define the cutoff value. Subgroup analysis based on the therapeutic strategies used subsequently indicated the significant prognostic value of SUV. Conclusion In conclusion, our meta-analysis indicated that pretreatment SUV in primary lesions can be an important prognostic factor for overall survival and recurrence-free survival in patients with gastric cancer. High SUVs may indicate poor prognosis.
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21
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Molecular biological correlation of fluorine-18 fluorodeoxyglucose uptake in esophageal squamous cell carcinoma. Nucl Med Commun 2017; 37:1053-61. [PMID: 27218430 DOI: 10.1097/mnm.0000000000000550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between fluorine-18 fluorodeoxyglucose (F-FDG) uptake and molecular biological markers in esophageal squamous cell carcinoma (ESCC) patients. METHODS Our patient population included 51 patients who underwent F-FDG PET/computed tomography before surgery. Excised tumor tissue was analyzed immunohistochemically using monoclonal antibodies for glucose transporter-1 (GLUT-1), GLUT-3, CD34 [microvessel density (MVD) marker], CD68 (macrophage marker), and CD163 (tumor-associated macrophage marker). The relationships among pathological factors [pathological T stage (p-T stage), pathological lymph node status (p-N status), pathological stage (p-stage), and pathological tumor length], the maximum standardized uptake value (SUVmax), and these molecular biological markers were evaluated using Spearman's rank test and the Kruskal-Wallis test. RESULTS GLUT-1, GLUT-3, CD34, and CD163 significantly correlated with SUVmax (r=0.547, P<0.001 for GLUT-1; r=0.569, P<0.001 for GLUT-3; r=0.463, P=0.001 for CD34, r=0.455, P=0.001 for CD163), whereas SUVmax, GLUT-1, GLUT-3, CD34, and CD163 significantly correlated with p-T stage (r=0.552, P<0.001 for SUVmax, r=0.307, P=0.03 for GLUT-1, r=0.349, P=0.013 for GLUT-3, r=0.313, P=0.027 for CD34, r=0.526 for CD163, P<0.001), but not with p-N status. CD68 levels showed no significant correlation with SUVmax, p-T stage, p-stage, or p-N status. CONCLUSION SUVmax, GLUT-1 expression, GLUT-3 expression, MVD, and TAMs show a relationship with the tumor stage and extent of ESCC. GLUT-1, GLUT-3, MVD, and TAMs are associated with the mechanism of F-FDG uptake in ESCC.
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22
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Jeon J, Lee J, Moon D, Yang H, Kim M, Lee GK, Zo J. Prognostic significance of venous invasion and maximum standardized uptake value of 18F-FDG PET/CT in surgically resected T1N0 esophageal squamous cell carcinoma. Eur J Surg Oncol 2017; 43:471-477. [DOI: 10.1016/j.ejso.2016.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 11/01/2016] [Indexed: 12/22/2022] Open
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23
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Hagen PV, Heijl MV, van Berge Henegouwen MI, Boellaard R, Bossuyt PMM, Kate FJWT, Dekken HV, Hoekstra OS, Sloof GW, Lanschot JJBV. Prediction of disease-free survival using relative change in FDG-uptake early during neoadjuvant chemoradiotherapy for potentially curable esophageal cancer: A prospective cohort study. Dis Esophagus 2017; 30:1-7. [PMID: 27001344 DOI: 10.1111/dote.12479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) has been investigated as a tool for monitoring response to neoadjuvant chemo- and chemoradiotherapy (CT and CRT, respectively) and as a predictor for survival in patients with esophageal cancer. In contrast to patients who undergo neoadjuvant CT, it is not known whether patients who are clinically identified as responders after neoadjuvant CRT show better disease-free survival (DFS) than patients identified as nonresponders. The aim of the study was to determine the predictive value of FDG-uptake measured prior to and early during neoadjuvant CRT. Patients treated with neoadjuvant CRT between 2004 and 2009 within a randomized trial were included. FDG-uptake was measured at baseline and after 14 days of CRT. According to the PERCIST-criteria, patients were allocated to have metabolic response, stable disease, or progression. Patients were followed until recurrence of disease or death. The predictive value of FDG-PET was determined with univariable and multivariable analysis in patients who underwent potentially curative surgery. One-hundred and six patients were included in the analysis. Minimal follow-up for surviving patients was 60 months. No significant differences in DFS were found between patients with metabolic response, stable disease, or progression, with 5-year DFS rates of 66%, 53%, and 67%, respectively (P = 0.39). Relative change in FDG uptake after 14 days of CRT is not associated with DFS in patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy followed by surgery. These measurements should not be used for prognostication in this specific group of patients.
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Affiliation(s)
- P V Hagen
- Department of Surgery, Erasmus Medical Center, Rotterdam
| | - M V Heijl
- Department of Surgery, Academic Medical Center, Amsterdam
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - R Boellaard
- Department of Nuclear Medicine and PET research, VU Medical Center, Amsterdam
| | - P M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam
| | - F J W T Kate
- Department of Pathology, Academic Medical Center, Amsterdam
- Department of Pathology, Erasmus Medical Center, Rotterdam
| | - H V Dekken
- Department of Pathology, Erasmus Medical Center, Rotterdam
- Department of Pathology, Sint Lucas Andreas Hospital, Amsterdam
| | - O S Hoekstra
- Department of Nuclear Medicine and PET research, VU Medical Center, Amsterdam
| | - G W Sloof
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam
- Department of Nuclear Medicine, Groene Hart Hospital, Gouda
| | - J J B V Lanschot
- Department of Surgery, Erasmus Medical Center, Rotterdam
- Department of Surgery, Academic Medical Center, Amsterdam
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Huang YC, Lu HI, Huang SC, Hsu CC, Chiu NT, Wang YM, Chiu YC, Li SH. FDG PET using SUV max for preoperative T-staging of esophageal squamous cell carcinoma with and without neoadjuvant chemoradiotherapy. BMC Med Imaging 2017; 17:1. [PMID: 28056868 PMCID: PMC5217536 DOI: 10.1186/s12880-016-0171-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 12/06/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Accurate T-staging is pivotal for predicting prognosis and selecting appropriate therapies for esophageal squamous cell carcinoma (ESCC). The diagnostic performance of fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for its T-staging is uncertain. We investigated use of FDG PET/CT for preoperative T-staging of patients with ESCC. METHODS Patients with ESCC given preoperative FDG PET/CT scans, either with (CRT[+] group) or without (CRT[-] group) neoadjuvant chemoradiotherapy, were retrospectively reviewed. Maximal standardized uptake value (SUVmax) of the primary tumors on FDG PET/CT scans were measured, and histopathological results were used as the reference standard. The associations between pathological T-stage and potential factors of age, tumor location, tumor grade, tumor size, and tumor SUVmax were analyzed. The cut-off levels of SUVmax for predicting different T-stages and for residual viable tumors after neoadjuvant chemoradiotherapy were determined using receiver operating characteristic analyses. RESULTS We enrolled 103 patients (45 in the CRT[-] group; 58 in the CRT[+] group). SUVmax, an independent predictive factor, positively correlated with the pathological T-stage in both groups (CRT[-] group: ρ = 0.736, p < 0.001; and CRT[+] group: ρ = 0.792, p < 0.001). The overall accuracy of the PET/CT with thresholded SUVmax for predicting the pathological T-stage was 73.3% in the CRT[-] group (SUVmax of T0: 0-1.9, T1: 2.0-4.4, T2: 4.5-6.5, T3: 6.6-13.0, T4: >13.0) and 67.2% in the CRT[+] group (SUVmax of T0: 0-3.4, T1: 3.5-3.9, T2: 4.0-5.5, T3: 5.6-6.2, T4: > 6.2). For CRT[-] group, the accuracy using an SUVmax cut-off of 4.4 to differentiate early (T0-1) from locally advanced disease (T2-4) was 82.2% (95% CI, 71.1-93.4%). For CRT[+] group, the accuracy using an SUVmax cut-off of 3.4 to predict residual viable tumors (non-T0) after completion of chemoradiotherapy was 82.8% (95% CI, 73.0-92.5%). CONCLUSIONS The FDG avidity of a primary esophageal tumor significantly positively correlated with the pathological T-stage. PET/CT with thresholded SUVmax was useful for predicting T-stage and differentiating residual viable tumors.
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Affiliation(s)
- Yung-Cheng Huang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Chen Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Chin Hsu
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nan-Tsing Chiu
- Department of Nuclear Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Department of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Cross-Sectional Imaging of the Oesophagus Using CT and PET/Techniques. Dysphagia 2017. [DOI: 10.1007/174_2017_131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tan TH, Boey CY, Lee BN. Role of Pre-therapeutic (18)F-FDG PET/CT in Guiding the Treatment Strategy and Predicting Prognosis in Patients with Esophageal Carcinoma. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2016; 4:59-65. [PMID: 27408893 PMCID: PMC4938875 DOI: 10.7508/aojnmb.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the role of pre-therapeutic (18)fluorine-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) and maximum standardized uptake value (SUVmax) in guiding the treatment strategy and predicting the prognosis of esophageal carcinoma, using the survival data of the patients. METHODS The present retrospective, cohort study was performed on 40 consecutive patients with esophageal carcinoma (confirmed by endoscopic biopsy), who underwent pre-operative (18)F-FDG PET-CT staging between January 2009 and June 2014. All the patients underwent contrast-enhanced CT and non-contrasted (18)F-FDG PET-CT evaluations. The patients were followed-up over 12 months to assess the changes in therapeutic strategies. Survival analysis was done considering the primary tumor SUVmax, using the Kaplan-Meier product-limit method. RESULTS In a total of 40 patients, (18)F-FDG PET-CT scan led to changes in disease stage in 26 (65.0%) cases, with upstaging and downstaging reported in 10 (25.0%) and 16 (40.0%) patients, respectively. The management strategy changed from palliative to curative in 10 out of 24 patients and from curative to palliative in 7 out of 16 cases. Based on the (18)F-FDG PET-CT scan alone, the median survival of patients in the palliative group was 4.0 (95% CI 3.0-5.0) months, whereas the median survival in the curative group has not been reached, based on the 12-month follow-up. Selection of treatment strategy on the basis of (18)F-FDG PET/CT alone was significantly associated with the survival outcomes at nine months (P=0.03) and marginally significant at 12 months (P=0.03). On the basis of SUVmax, the relation between survival and SUVmax was not statistically significant. CONCLUSION (18)F-FDG PET/CT scan had a significant impact on stage stratification and subsequently, selection of a stage-specific treatment approach and the overall survival outcome in patients with esophageal carcinoma. However, pre-treatment SUVmax failed to stablish its usefulness in the assessment of patient prognosis and survival outcome.
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Affiliation(s)
- Teik Hin Tan
- Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia
| | - Ching Yeen Boey
- Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia
| | - Boon Nang Lee
- Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia
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Paumier A, Marquis A, Trémolières P, Lacombe M, Capitain O, Septans AL, Peyraga G, Gustin P, Vénara A, Ménager É, Visvikis D, Couturier O, Rio E, Hatt M. [Prognostic value of the metabolically active tumour volume]. Cancer Radiother 2016; 20:24-9. [PMID: 26762703 DOI: 10.1016/j.canrad.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/09/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to assess the prognostic value of different parameters on pretreatment fluorodeoxyglucose [((18)F)-FDG] positron emission tomography-computed tomography (PET-CT) in patients with localized oesophageal cancer. PATIENTS AND METHOD We retrospectively reviewed 83 cases of localised oesophageal cancer treated in our institution. Patients were treated with curative intent and have received chemoradiotherapy alone or followed by surgery. Different prognostic parameters were correlated to survival: cancer-related factors, patient-related factors and parameters derived from PET-CT (maximum standardized uptake value [SUV max], metabolically active tumor volume either measured with an automatic segmentation software ["fuzzy locally adaptive bayesian": MATVFLAB] or with an adaptive threshold method [MATVseuil] and total lesion glycolysis [TLGFLAB and TLGseuil]). RESULTS The median follow-up was 21.8 months (range: 0.16-104). The median overall survival was 22 months (95% confidence interval [95%CI]: 15.2-28.9). There were 67 deaths: 49 associated with cancer and 18 from intercurrent causes. None of the tested factors was significant on overall survival. In univariate analysis, the following three factors affected the specific survival: MATVFLAB (P=0.025), TLGFLAB (P=0.04) and TLGseuil (P=0.04). In multivariate analysis, only MATVFLAB had a significant impact on specific survival (P=0.049): MATVFLAB<18 cm(3): 31.2 months (95%CI: 21.7-not reached) and MATVFLAB>18 cm(3): 20 months (95%CI: 11.1-228.9). CONCLUSION The metabolically active tumour volume measured with the automatic segmentation software FLAB on baseline PET-CT was a significant prognostic factor, which should be tested on a larger cohort.
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Affiliation(s)
- A Paumier
- Service de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France.
| | - A Marquis
- Service de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France
| | - P Trémolières
- Service de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France
| | - M Lacombe
- Service de médecine nucléaire, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France
| | - O Capitain
- Service d'oncologie médicale, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France
| | - A-L Septans
- Département de recherche clinique, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France
| | - G Peyraga
- Service de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France
| | - P Gustin
- Service de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue Boquel, CS 10059, 49055 Angers cedex 02, France
| | - A Vénara
- Service de chirurgie viscérale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - É Ménager
- Service d'hépatogastroentérologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - D Visvikis
- Inserm, UMR 1101, Laboratoire de traitement de l'information médicale (Latim), 2, avenue Maréchal-Foch, 29200 Brest, France; UMR 1101, CHRU Morvan, 2, avenue Maréchal-Foch, 29200 Brest, France
| | - O Couturier
- Service de médecine nucléaire, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - E Rio
- Service de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - M Hatt
- Inserm, UMR 1101, Laboratoire de traitement de l'information médicale (Latim), 2, avenue Maréchal-Foch, 29200 Brest, France; UMR 1101, CHRU Morvan, 2, avenue Maréchal-Foch, 29200 Brest, France
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Lin J, Kligerman S, Goel R, Sajedi P, Suntharalingam M, Chuong MD. State-of-the-art molecular imaging in esophageal cancer management: implications for diagnosis, prognosis, and treatment. J Gastrointest Oncol 2015; 6:3-19. [PMID: 25642333 DOI: 10.3978/j.issn.2078-6891.2014.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/02/2014] [Indexed: 11/14/2022] Open
Abstract
Molecular imaging techniques are increasingly being used in addition to standard imaging methods such as endoscopic ultrasound (EUS) and computed tomography (CT) for many cancers including those of the esophagus. In this review, we will discuss the utility of the most widely used molecular imaging technique, (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET). (18)F-FDG PET has a variety of potential applications ranging from improving staging accuracy at the time of initial diagnosis to assisting in radiation target volume delineation. Furthermore, (18)F-FDG PET can be used to evaluate treatment response after completion of neoadjuvant therapy or potentially during neoadjuvant therapy. Finally, we will also discuss other novel molecular imaging techniques that have potential to further improve cancer care.
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Affiliation(s)
- Jolinta Lin
- 1 Department of Radiation Oncology, 2 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Systems, Baltimore, USA ; 3 Department of Diagnostic Imaging, Baltimore Veterans Affairs Medical Center, Baltimore, USA
| | - Seth Kligerman
- 1 Department of Radiation Oncology, 2 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Systems, Baltimore, USA ; 3 Department of Diagnostic Imaging, Baltimore Veterans Affairs Medical Center, Baltimore, USA
| | - Rakhi Goel
- 1 Department of Radiation Oncology, 2 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Systems, Baltimore, USA ; 3 Department of Diagnostic Imaging, Baltimore Veterans Affairs Medical Center, Baltimore, USA
| | - Payam Sajedi
- 1 Department of Radiation Oncology, 2 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Systems, Baltimore, USA ; 3 Department of Diagnostic Imaging, Baltimore Veterans Affairs Medical Center, Baltimore, USA
| | - Mohan Suntharalingam
- 1 Department of Radiation Oncology, 2 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Systems, Baltimore, USA ; 3 Department of Diagnostic Imaging, Baltimore Veterans Affairs Medical Center, Baltimore, USA
| | - Michael D Chuong
- 1 Department of Radiation Oncology, 2 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Systems, Baltimore, USA ; 3 Department of Diagnostic Imaging, Baltimore Veterans Affairs Medical Center, Baltimore, USA
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PET/CT predicts survival in patients undergoing primary surgery for esophageal cancer. Langenbecks Arch Surg 2015; 400:229-35. [DOI: 10.1007/s00423-014-1264-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 12/14/2014] [Indexed: 12/22/2022]
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Su B, Xu B, Wan J. Correlation between long-term aspirin use and F-fluorodeoxyglucose uptake in colorectal cancer measured by PET/CT. PLoS One 2014; 9:e109459. [PMID: 25290692 PMCID: PMC4188583 DOI: 10.1371/journal.pone.0109459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/09/2014] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the relationship between long-term aspirin use with pretreatment 18 Fluorodeoxyglucose (FDG) uptake of primary lesions of Colorectal cancer (CRC) and evaluate their clinical significance. MATERIALS AND METHODS We enrolled 84 patients with CRC who underwent 18F-FDG PET/CT scanning before surgery between 1st July 2008 and 1st March 2013 and followed up until 1st March 2014. Maximum standardized uptake value (SUVmax) of the primary tumor was measured by 18F-FDG PET/CT. The history of aspirin taken and other clinicopathogical factors were also obtained and their relationships were examined by Mann-Whitney or χ2 tests. Progression-free survival (PFS) was determined by standard Kaplan-Meier survival analysis. Cox proportional hazards regression was performed to determine whether history of aspirin taken, pretreatment SUVmax, age, gender, TNM stage, tumor sizes and differentiation influenced outcomes. RESULTS CRC Patients with long-term history of aspirin use had lower SUVmax of primary lesions than control group (9.74±2.62 vs. 13.91±6.18) and showed a trend towards improved PFS after curative surgery. However, pretreatment of SUVmax showed no prognostic value in patients with CRC. CONCLUSIONS Long-term aspirin use is associated with lower pretreatment SUVmax of CRC and is a promising prognostic factor for predicting PFS in patients with CRC.
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Affiliation(s)
- Binbin Su
- Department of Gastroenterology, South Building, Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China
- * E-mail: (JW); (BX)
| | - Jun Wan
- Department of Gastroenterology, South Building, Chinese PLA General Hospital, Beijing, China
- * E-mail: (JW); (BX)
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Al-Taan OS, Eltweri A, Sharpe D, Rodgers PM, Ubhi SS, Bowrey DJ. Prognostic value of baseline FDG uptake on PET-CT in esophageal carcinoma. World J Gastrointest Oncol 2014; 6:139-144. [PMID: 24834144 PMCID: PMC4021330 DOI: 10.4251/wjgo.v6.i5.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/19/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the influence of baseline maximum standardized uptake value (SUVmax) on survival in a cohort of patients, undergoing positron emission tomography-computed tomography (PET-CT) scan for esophageal carcinoma.
METHODS: The pre-treatment SUVmax numeric reading was determined in patients with confirmed esophageal or junctional cancer having PET-CT scan during the time period 1st January 2007 until 31st July 2012. A minimum follow up of 12 mo was required. Patients were subdivided into quartiles according to SUVmax value and the influence of SUVmax on survival was assessed using univariate and multivariate analysis. The following pre-treatment factors were investigated: patient characteristics, tumor characteristics and planned treatment.
RESULTS: The study population was 271 patients (191 male) with esophageal or junctional carcinoma. The median age was 65 years (range 40-85) and histologic subtype was adenocarcinoma in 197 patients and squamous carcinoma in 74 patients. The treatment intent was radical in 182 and palliative in 89 patients. SUVmax was linked to histologic subtype (P = 0.008), tumor site (P = 0.01) and Union for International Cancer Control (UICC) stage (P < 0.001). On univariate analysis, prognosis was significantly associated with SUVmax (P = 0.001), T-stage (P < 0.001) and UICC stage (P < 0.001). On multivariate analysis, only T-stage and UICC stage remained significant.
CONCLUSION: Pretreatment SUVmax was not a useful marker in isolation for determining prognosis of patients with esophageal carcinoma.
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Foley KG, Fielding P, Lewis WG, Karran A, Chan D, Blake P, Roberts SA. Prognostic significance of novel ¹⁸F-FDG PET/CT defined tumour variables in patients with oesophageal cancer. Eur J Radiol 2014; 83:1069-1073. [PMID: 24794862 DOI: 10.1016/j.ejrad.2014.03.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) combined with computed tomography (PET/CT) is now established as a routine staging investigation of oesophageal cancer (OC). The aim of the study was to determine the prognostic significance of PET/CT defined tumour variables including maximum standardised uptake value (SUVmax), tumour length (TL), metastatic length of disease (MLoD), metabolic tumour volume (MTV), total lesion glycolysis (TLG) and total local nodal metastasis count (PET/CT LNMC). MATERIALS AND METHODS 103 pre-treatment OC patients (76 adenocarcinoma, 25 squamous cell carcinoma, 1 poorly differentiated and 1 neuroendocrine tumour) were staged using PET/CT. The prognostic value of the measured tumour variables were tested using log-rank analysis of the Kaplan-Meier method and Cox's proportional hazards method. Primary outcome measure was survival from diagnosis. RESULTS Univariate analysis showed all variables to have strong statistical significance in relation to survival. Multivariate analysis demonstrated three variables that were significantly and independently associated with survival; MLoD (HR 1.035, 95% CI 1.008-1.064, p=0.011), TLG (HR 1.002, 95% CI 1.000-1.003, p=0.018) and PET/CT LNMC (HR 0.048-0.633, 95% CI 0.005-2.725, p=0.015). CONCLUSION MLoD, TLG, and PET/CT LNMC are important prognostic indicators in OC. This is the first study to demonstrate an independent statistical association between TLG, MLoD and survival by multivariable analysis, and highlights the value of staging OC patients with PET/CT using functional tumour variables.
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Affiliation(s)
- Kieran G Foley
- Department of Radiology, University Hospital of Wales, Cardiff, UK.
| | - Patrick Fielding
- Department of Wales Research & Diagnostic Positron Emission Tomography Imaging Centre (PETIC), University Hospital of Wales, Cardiff, UK.
| | - Wyn G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff, UK.
| | - Alex Karran
- Department of Surgery, University Hospital of Wales, Cardiff, UK.
| | - David Chan
- Department of Surgery, University Hospital of Wales, Cardiff, UK.
| | - Paul Blake
- Department of Surgery, University Hospital of Wales, Cardiff, UK.
| | - S Ashley Roberts
- Department of Radiology, University Hospital of Wales, Cardiff, UK.
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Pretreatment metabolic tumor volumes to predict the short-term outcome of unresectable locally advanced squamous cell carcinoma of the esophagus treated with definitive chemoradiotherapy. Nucl Med Commun 2014; 35:291-7. [DOI: 10.1097/mnm.0000000000000046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kajiwara T, Hiasa Y, Nishina T, Matsumoto T, Hori S, Nadano S, Iguchi H, Takeji S, Tsubouchi E, Ikeda Y, Onji M. Maximum standardized uptake value in 18F-fluoro-2-deoxyglucose positron emission tomography is associated with advanced tumor factors in esophageal cancer. Mol Clin Oncol 2014; 2:313-321. [PMID: 24649354 DOI: 10.3892/mco.2014.238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 12/19/2013] [Indexed: 12/22/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-2-deoxyglucose (FDG-PET/CT) has become established in cancer imaging, and derived maximum standardized uptake values (SUVmax) add functional information regarding cancer, including esophageal squamous cell carcinoma (ESCC). The aim of the present study was to determine the clinical significance and association of tumor progression using SUVmax derived from PET/CT images in patients with ESCC. In total, 101 patients with ESCC were assessed using FDG-PET/CT and the SUVmax was then compared with the clinical backgrounds and prognoses of the patients. Endoscopic ESCC biopsy specimens were obtained in order to analyze mRNA expression relative to tumor progression. The results showed that values for SUVmax were significantly higher in patients with tumor progression factors, particularly those with lymph node metastasis. Analysis of receiver operating characteristics curves revealed an optimum SUVmax cut-off value of 10.26 for node-positive disease. Patients with SUVmax ≥10.26 had gene alterations with epithelial-mesenchymal transition (EMT) and significantly worse overall survival (P=0.0012). A higher SUVmax in patients with ESCC was associated with lymph node metastasis and a poorer prognosis. Thus, the SUVmax may reflect the potential of EMT in patients with ESCC.
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Affiliation(s)
- Takeshi Kajiwara
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Tomohiro Nishina
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Toshihiko Matsumoto
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Shinichiro Hori
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Seijin Nadano
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Haruo Iguchi
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Satoru Takeji
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Eiji Tsubouchi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Yoshio Ikeda
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Morikazu Onji
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
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Tan Z, Chen Y, Ma G, Meng Y, Fu J, Zhang L, Long H, Rong T, Lin P. Validation of the 7th edition American Joint Committee on cancer staging system for esophageal squamous cell carcinoma. Thorac Cancer 2013; 4:410-415. [PMID: 28920222 DOI: 10.1111/1759-7714.12039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 02/24/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study is to investigate the ability of the 7th edition of the American Joint Committee on Cancer tumor-nodes-metastasis (AJCC/TNM) staging system to distinguish between patients at higher risk and to predict the overall survival in patients who underwent surgical resection for esophageal squamous cell carcinoma (ESCC). METHODS Between 1998 and 2008, 560 patients with ESCC underwent R0 tri-incisional esophagectomy at our center without neoadjuvant or adjuvant therapy. We performed univariate and multivariate analyses to identify prognostic factors for survival. RESULTS The five-year overall survival rate was 44.1%, with a median survival of 44 months. Gender, pT status, pN status, and the retrieved lymph nodes (LNs) category (<15 vs. ≥15) were found to be significant prognostic factors, whereas histology grade and tumor location were not significant prognostic factors in our analysis. When classified as all eight sub-stages, there were similar survival curves between stages IB and IIA (P = 0.799), and stages IIIC and IV (P = 0.635). Multivariate Cox proportional hazard regression analysis indicated that gender, pT category, pN category, and the retrieved LNs category (<15 vs. ≥15) were significantly associated with patient survival. CONCLUSION The 7th edition AJCC staging system proposed a new descriptor for "N" classification. Further stratification of pN status according to number of positive LNs in the 7th edition is valuable. However, we did not find tumor location and histology grade were significant prognostic factors. Moreover, adding a substantially higher threshold of LNs retrieved in the next revision of the AJCC/TNM staging system for ESCC may be more valuable.
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Affiliation(s)
- Zihui Tan
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuan Chen
- Institute of Hepatology, University College London, Royal Free Hospital, London, UK
| | - Guowei Ma
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuqi Meng
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianhua Fu
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lanjun Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao Long
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tiehua Rong
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Peng Lin
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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Sun M, Li B, Fu Z, Wei Y, Zhang J, Sun H, Li H, Feng R. Relationship between (18)F-fluorodeoxyglucose uptake in primary lesions and clinicopathological characteristics of esophageal squamous cell carcinoma patients. Exp Ther Med 2012; 5:170-174. [PMID: 23251261 PMCID: PMC3524285 DOI: 10.3892/etm.2012.772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 09/18/2012] [Indexed: 12/21/2022] Open
Abstract
The aim of this study, was to investigate the relationship between 18F-fluorodeoxyglucose (18F-FDG) uptake in primary tumors and the clinicopathological characteristics of esophageal squamous cell carcinoma (ESCC) patients. Patients with histopathologically diagnosed ESCC who had received a pre-therapeutic 18F-FDG positron emission tomography-computed tomography (PET-CT) scan were enrolled in the study. The maximum standardized uptake value (SUVmax) and the length of the primary tumor were measured by PET-CT. The clinical tumor-node-metastasis (TNM) stage was determined mainly by PET-CT images according to the American Joint Committee on Cancer (AJCC) staging system, 2002. A significant difference was observed in SUVmax between the length and T stage of the primary tumor (P=0.000 and P=0.017, respectively), but not in the grade of tumor differentiation (P=0.383), clinical stage (P=0.583), N staging (P=0.387), M staging (P=0.886), patient age (P= 0.752) or gender (P=0.233). There was a significant positive correlation between the SUVmax and the length of the tumor (r=0.456, P=0.000) and the depth of invasion of the primary tumor (r=0.257, P=0.006). After controlling for length, no statistically significant correlation was found between T stage and SUVmax (r=0.074, P=0.537). In conclusion, these findings suggest that tumor length influences FDG uptake in ESCC tumors, and that the T stage of the primary tumor is not significantly correlated with the SUVmax after controlling for length. However, we did not find a significant correlation between the SUVmax and primary tumor differentiation and clinical stage. These data provide important information for the management of ESCC.
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Affiliation(s)
- Mingping Sun
- Department of Radiation Oncology (Chest Section)
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37
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Lee JE, Kim SW, Kim JS, Choi KY, Kang WK, Oh ST, Yoo IR, Kim SH. Prognostic value of 18-fluorodeoxyglucose positron emission tomography-computed tomography in resectable colorectal cancer. World J Gastroenterol 2012; 18:5072-7. [PMID: 23049216 PMCID: PMC3460334 DOI: 10.3748/wjg.v18.i36.5072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/09/2012] [Accepted: 03/20/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the prognostic value of preoperative 18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) in patients with resectable colorectal cancer.
METHODS: One hundred sixty-three patients with resectable colorectal cancer who underwent FDG-PET/CT before surgery were included. Patient data including pathologic stage at presentation, histology, treatment, disease-free survival and the maximum standardized uptake value (SUVmax) of the primary tumor on FDG-PET/CT were retrospectively analyzed. Median follow up duration was 756 (range, 419-1355). The primary end point was disease-free survival.
RESULTS: Twenty-five of 163 patients (15.3%) had recurrences. The median SUVmax values of the recurrence and no-recurrence groups were 8.9 (range, 5-24) and 8.2 (range, 0-23, P = 0.998). Receiver operating characteristic (ROC) curve analysis showed no significant association between SUVmax and recurrence (area under the curve = 0.5, P = 0.998, 95% CI: 0.389-0.611). Because a statistically significant value was not found, SUVmax was dichotomized at its median of 8.6. The disease-free survival curve was analyzed using the median SUVmax (8.6) as the cut off. Univariate and multivariate analysis did not provide evidence that disease-free survival rates for the subgroups defined by the median SUVmax were significantly different (P = 0.52, P = 0.25).
CONCLUSION: Our study suggests that the high FDG uptake of primary mass in resectable colorectal cancer doesn’t have a significant relationship with tumor recurrence and disease-free survival.
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Preoperative staging of clinically node-negative esophageal cancer by the combination of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG–PET/CT). Esophagus 2012. [DOI: 10.1007/s10388-012-0342-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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39
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Barber TW, Duong CP, Leong T, Bressel M, Drummond EG, Hicks RJ. 18F-FDG PET/CT has a high impact on patient management and provides powerful prognostic stratification in the primary staging of esophageal cancer: a prospective study with mature survival data. J Nucl Med 2012; 53:864-71. [PMID: 22582047 DOI: 10.2967/jnumed.111.101568] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED The aim of this study is to evaluate the incremental staging information, management impact, and prognostic stratification of PET/CT in the primary staging of esophageal cancer in a cohort of patients with mature survival data. METHODS Between July 2002 and June 2005, 139 consecutive patients with newly diagnosed esophageal cancer underwent conventional staging investigations (CSI), followed by PET/CT. Disease stage was classified according to the American Joint Committee on Cancer staging system (6th edition) and grouped as stage I-IIA, stage IIB-III, and stage IV reflecting broad groupings that determine therapeutic choice. Validation of results was performed when PET/CT and CSI stage groups were discordant and in those patients where PET/CT changed management. Management impact was determined by comparing prospectively recorded pre-PET/CT management plans with post-PET/CT management plans. Survival after follow-up of at least 5 y in patients was analyzed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. RESULTS PET/CT changed the stage group in 56 of 139 (40%) patients and changed management in 47 of 139 (34%) patients. In 22 patients, therapy was changed from curative to palliative and in 3 from palliative to curative; in 11, treatment modality was changed without a change in treatment intent, and in 11 the delivery of therapy or diagnostic procedure was changed. Of the 47 patients with management change, imaging results could be validated in 31 patients, and PET/CT correctly changed management in 26 (84%) of these. Of the remaining 5 patients, CSI stage was also incorrect in 4 and correct in 1. Median survival was 23 mo. PET/CT stages I-IIA, IIB-III, and IV had a 5-y survival of 40%, 38%, and 6%, respectively. Post-PET/CT stage group and treatment intent were both strongly associated with survival (P < 0.001). CONCLUSION PET/CT provides incremental staging information compared with CSI, changes management in one third of patients, and has powerful prognostic stratification in the primary staging of esophageal cancer.
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Affiliation(s)
- Thomas W Barber
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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40
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Metabolic response at repeat PET/CT predicts pathological response to neoadjuvant chemotherapy in oesophageal cancer. Eur Radiol 2012; 22:2035-43. [PMID: 22562089 DOI: 10.1007/s00330-012-2459-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/02/2012] [Accepted: 02/20/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Reports have suggested that a reduction in tumour 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) examination during or after neoadjuvant chemotherapy may predict pathological response in oesophageal cancer. Our aim was to determine whether metabolic response predicts pathological response to a standardised neoadjuvant chemotherapy regimen within a prospective clinical trial. METHODS Consecutive patients staged with potentially curable oesophageal cancer who underwent treatment within a non-randomised clinical trial were included. A standardised chemotherapy regimen (two cycles of oxaliplatin and 5-fluorouracil) was used. PET/CT was performed before chemotherapy and repeated 24-28 days after the start of cycle 2. RESULTS Forty-eight subjects were included: mean age 65 years; 37 male. Using the median percentage reduction in SUV(max) (42%) to define metabolic response, pathological response was seen in 71% of metabolic responders (17/24) compared with 33% of non-responders (8/24; P = 0.009, sensitivity 68%, specificity 70%). Pathological response was seen in 81% of subjects with a complete metabolic response (13/16) compared with 38% of those with a less than complete response (12/32; P = 0.0042, sensitivity 52%, specificity 87%). There was no significant histology-based effect. CONCLUSIONS There was a significant association between metabolic response and pathological response; however, accuracy in predicting pathological response was relatively low.
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Brown C, Howes B, Jamieson GG, Bartholomeusz D, Zingg U, Sullivan TR, Thompson SK. Accuracy of PET-CT in predicting survival in patients with esophageal cancer. World J Surg 2012; 36:1089-1095. [PMID: 22374537 DOI: 10.1007/s00268-012-1470-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Positron emission tomography (PET) is an integral part of tumor staging for patients with esophageal cancer. Recent studies suggest a role for PET scan in predicting survival in these patients, but this relationship is unclear in the setting of neoadjuvant therapy. We examined pretreatment maximum standard uptake value (SUV(max)) of the primary tumor in patients treated with and without neoadjuvant therapy. METHODS All patients undergoing esophagectomy with a preoperative PET scan over a nine-year period (2001-2010) were identified from a prospectively maintained database. Positron emission tomography data were obtained from computers housing the original PET scans. Overall survival was correlated with SUV(max) of the primary tumor. RESULTS A total of 191 patients were identified, and 103 patients met inclusion criteria. Eighty-two had an adenocarcinoma (80%), and 21 (20%) had a squamous cell carcinoma. Fifty-seven (55%) patients received neoadjuvant therapy. In the surgery alone group, a SUV(max) of > 5.0 in the primary tumor was associated with poor prognosis [Hazard Ratio (HR) 0.32; p = 0.007], but this factor did not retain its significance on multivariate analysis (HR 0.65; p = 0.43). Pretreatment SUV(max) in patients who underwent neoadjuvant therapy was not significant in predicting overall survival (p = 0.10). CONCLUSIONS This study does not support the use of SUV(max) on pretreatment PET scans as a prognostic tool for patients with esophageal cancer, especially in those who have received neoadjuvant therapy. Lymph node status is a more accurate predictor of outcome, and efforts to improve pretreatment staging should focus on this factor.
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Affiliation(s)
- Claire Brown
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Ben Howes
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Glyn G Jamieson
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Dylan Bartholomeusz
- Department of Nuclear Medicine, PET and Bone Densitometry, and Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Urs Zingg
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Thomas R Sullivan
- Discipline of Public Health, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Sarah K Thompson
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.
- Department of Surgery, Royal Adelaide Hospital, Level 5, Eleanor Harrald Building, Adelaide, SA, 5000, Australia.
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Gillies RS, Middleton MR, Han C, Marshall REK, Maynard ND, Bradley KM, Gleeson FV. Role of positron emission tomography-computed tomography in predicting survival after neoadjuvant chemotherapy and surgery for oesophageal adenocarcinoma. Br J Surg 2012; 99:239-45. [PMID: 22329010 DOI: 10.1002/bjs.7758] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Positron emission tomography combined with computed tomography (PET-CT) is increasingly being used in the staging of oesophageal cancer. Some recent reports suggest it may be used to predict survival. None of these studies, however, reported on the prognostic value of PET-CT performed before neoadjuvant chemotherapy and surgery. The aim of this study was to determine whether pretreatment PET-CT could predict survival. METHODS Consecutive patients with oesophageal adenocarcinoma who underwent PET-CT before neoadjuvant chemotherapy and resection were included. Maximum standardized uptake value (SUV(max)), fluorodeoxyglucose (FDG)-avid tumour length and the presence of FDG-avid local lymph nodes were determined for all patients. Kaplan-Meier survival analysis was performed and multivariable analysis used to identify independent prognostic factors. RESULTS A total of 121 patients were included (mean age 63 years, 97 men) of whom 103 underwent surgical resection. On an intention-to-treat basis, overall survival was significantly worse in patients with FDG-avid local lymph nodes (P < 0·001). SUV(max) and FDG-avid tumour length did not predict survival (P = 0·276 and P = 0·713 respectively). The presence of FDG-avid local lymph nodes was an independent predictor of poor overall survival (hazard ratio (HR) 4·75, 95 per cent confidence interval 2·14 to 10·54; P < 0·001) and disease-free survival (HR 2·97, 1·40 to 6·30; P = 0·004). CONCLUSION The presence of FDG-avid lymph nodes, but not SUV(max) or FDG-avid tumour length, was an independent adverse prognostic factor.
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Affiliation(s)
- R S Gillies
- Department of Oncology, Oxford Cancer and Haematology Centre, Oxford, UK.
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43
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Preoperative Work-up: PET and PET-CT. Updates Surg 2012. [DOI: 10.1007/978-88-470-2330-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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44
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Cross-Sectional Imaging of the Oesophagus Using CT and PET/Techniques. Dysphagia 2012. [DOI: 10.1007/174_2012_656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ganeshan B, Skogen K, Pressney I, Coutroubis D, Miles K. Tumour heterogeneity in oesophageal cancer assessed by CT texture analysis: preliminary evidence of an association with tumour metabolism, stage, and survival. Clin Radiol 2011; 67:157-64. [PMID: 21943720 DOI: 10.1016/j.crad.2011.08.012] [Citation(s) in RCA: 246] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 07/25/2011] [Accepted: 08/01/2011] [Indexed: 12/22/2022]
Abstract
AIM To undertake a pilot study assessing whether tumour heterogeneity evaluated using computed tomography texture analysis (CTTA) has the potential to provide a marker of tumour aggression and prognosis in oesophageal cancer. MATERIALS AND METHODS In 21 patients, unenhanced CT images of the primary oesophageal lesion obtained using positron-emission tomography (PET)-CT examinations underwent CTTA. CTTA was carried out using a software algorithm that selectively filters and extracts textures at different anatomical scales between filter values 1.0 (fine detail) and 2.5 (coarse features) with quantification as entropy and uniformity (measures image heterogeneity). Texture parameters were correlated with average tumour 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) uptake [standardized uptake values (SUV(mean) and SUV(max))] and clinical staging as determined by endoscopic ultrasound (nodal involvement) and PET-CT (distant metastases). The relationship between tumour stage, FDG uptake, and texture with survival was assessed using Kaplan-Meier analysis. RESULTS Tumour heterogeneity correlated with SUV(max) and SUV(mean). The closest correlations were found for SUV(mean) measured as uniformity and entropy with coarse filtration (r=-0.754, p<0.0001; and r=0.748, p=0.0001 respectively). Heterogeneity was also significantly greater in patients with clinical stage III or IV for filter values between 1.0 and 2.0 (maximum difference at filter value 1.5: entropy: p=0.027; uniformity p=0.032). The median (range) survival was 21 (4-34) months. Tumour heterogeneity assessed by CTTA (coarse uniformity) was an independent predictor of survival [odds ratio (OR)=4.45 (95% CI: 1.08, 18.37); p=0.039]. CONCLUSION CTTA assessment of tumour heterogeneity has the potential to identify oesophageal cancers with adverse biological features and provide a prognostic indicator of survival.
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Affiliation(s)
- B Ganeshan
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton BN1 9RR, UK.
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Hsu PK, Lin KH, Wang SJ, Huang CS, Wu YC, Hsu WH. Preoperative positron emission tomography/computed tomography predicts advanced lymph node metastasis in esophageal squamous cell carcinoma patients. World J Surg 2011; 35:1321-6. [PMID: 21476114 DOI: 10.1007/s00268-011-1081-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND We aimed to study whether positron emission tomography/computed tomography (PET/CT) findings are associated with lymph node staging, as outlined by the 7th edition American Joint Committee on Cancer (AJCC) TNM staging system in patients with esophageal squamous cell carcinoma (ESCC). METHODS A series of 76 ESCC patients undergoing esophagectomy were included in this study. The relation between PET/CT findings [maximum standardized uptake value (SUVmax)] and pathologic lymph node status (N stage) was studied. RESULTS The SUVmax of extra-tumor uptake, but not that of the main tumor, was significantly associated with the N classification. N2/N3 disease was observed in 61.1% of patients with an SUVmax for extra-tumor uptake of >4.9, whereas only 17.2% of patients with an SUVmax of extra-tumor uptake of <4.9 were classified as N2/N3 The number of PET abnormalities (NPAs) was also significantly associated with the N classification. Patients with three or more NPAs had a 65% chance of being classified as N2/N3, whereas patients with one or two NPAs had less than a 20% chance of being classified as N2/N3. CONCLUSIONS The SUVmax of extra-tumor uptake and the NPAs were significantly associated with the N classification outlined by the 7th edition of the AJCC TNM staging system. PET/CT does help identify patients with advanced lymph node metastasis (N2/N3 stage) instead of simply indicating nodal involvement.
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Affiliation(s)
- Po-Kuei Hsu
- Department of Surgery, Chutung Veterans Hospital, Chutung, Hsinchu, Taiwan.
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Welsh J, Amini A, Likhacheva A, Erasmus J J, Gomez D, Davila M, Mehran RJ, Komaki R, Liao Z, Hofstetter WL, Lee H J, Bhutani MS, Ajani JA. Update: modern approaches to the treatment of localized esophageal cancer. Curr Oncol Rep 2011; 13:157-67. [PMID: 21365188 DOI: 10.1007/s11912-011-0158-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The optimal treatment strategy for esophageal cancer continues to be a topic of debate. Improvements in chemotherapy drugs, surgical techniques, and radiotherapy planning and delivery have led to the design of treatment approaches that are specific to both the stage of the tumor and the overall performance status of the patient. Surgery continues to be the standard treatment option for localized disease, but multimodality treatments that include radiation and chemotherapy with surgery are increasingly used. The next few years will continue to see improvements in radiation techniques, especially proton beam treatment; the development of additional minimally invasive surgical approaches to minimize postoperative side effects; and the discovery of molecular biomarkers to help specifically target treatment of esophageal cancer in individual patients.
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Affiliation(s)
- James Welsh
- Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Yasuda T, Higuchi I, Yano M, Miyata H, Yamasaki M, Takiguchi S, Fujiwara Y, Hatazawa J, Doki Y. The impact of ¹⁸F-fluorodeoxyglucose positron emission tomography positive lymph nodes on postoperative recurrence and survival in resectable thoracic esophageal squamous cell carcinoma. Ann Surg Oncol 2011; 19:652-60. [PMID: 21769466 DOI: 10.1245/s10434-011-1928-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND Induction therapy is not always beneficial for all patients. Therefore, it is important to identify the patients with a high rate of recurrence. The occurrence of lymph node metastases (LNMs) strongly influences the postoperative survival in patients with esophageal cancer. We investigated the usefulness of an LN evaluation by initial (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in prediction of postoperative recurrence for patients with resectable esophageal squamous cell carcinoma (ESCC). METHODS A total of 76 ESCC patients who did not undergo induction therapy, but who did receive a curative resection were divided into PET-node (PET-N) positive (n = 26) and negative (n = 50) groups according to the presence or absence of FDG uptake in LNs. The PET-N status was compared with the size and the number of LNMs, as well as with the survival and failure patterns. RESULTS PET positive LNs involved a significantly larger size of metastatic nests than PET negative LNs (P = 0.002). The PET-N negative group showed a higher proportion of patients with 2 or fewer LNMs (92.0%), a higher 5-year relapse-free survival (75.1%) and a higher overall survival (70.0%), and a lower postoperative recurrence (24.0%) than the 15.4, 29.6, 30.3, and 69.2% values in the PET-N positive group, respectively, (P < 0.005). Multivariate analyses identified the PET-N status to be the most significant preoperative risk factor for postoperative recurrence (P = 0.031). CONCLUSION The preoperative PET-N status in patients with resectable ESCC was significantly associated with the size and the number of LNMs and was therefore found to reliably identify the high-risk population for postoperative recurrence.
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Affiliation(s)
- Takushi Yasuda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
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Nakajo M, Nakajo M, Tani A, Kajiya Y, Shimaoka S, Matsuda A, Nioh T, Nihara T, Suenaga T, Tanaka S, Shirahama H, Higashi M, Koriyama C. Clinical significance of primary lesion FDG uptake for choice between oesophagectomy and endoscopic submucosal dissection for resectable oesophageal squamous cell carcinomas. Eur Radiol 2011; 21:2396-407. [PMID: 21750887 DOI: 10.1007/s00330-011-2196-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/21/2011] [Accepted: 05/13/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To correlate primary oesophageal squamous cell carcinoma (SCC) (18)F-fluoro-deoxyglucose (FDG) uptake with pathological factors and examine its significance regarding choice of therapy. METHODS We retrospectively examined the factors affecting visible and non-visible FDG uptake in 37 primary lesions in 32 oesophageal SCC patients who underwent PET/CT before oesophagectomy or endoscopic submucosal dissection (ESD). We divided the lesions into pathological depth invasion ≥sm2 oesophagectomy (n = 18) and ≤sm1 ESD (n = 19) indicated groups and compared the diagnostic accuracy of FDG-PET with that of endoscopic ultrasound (EUS) performed for 23 superficial lesions to discriminate between these groups. RESULTS There were 17 visible and 20 non-visible lesions. The lesion visibility was significantly higher in the larger (≥40 mm), non-flat type, more deeply invaded, positive vascular invasion (P < 0.001 each), positive nodal metastasis (P = 0.04) and higher Glut-1 score (P = 0.005) tumour groups. When the visible and non-visible lesions indicated a need for oesophagectomy and ESD respectively, the sensitivity, specificity and accuracy of oesophagectomy were 94% (17/18), 100% (19/19) and 97% (36/37) and those of EUS were 75% (3/4), 79% (15/19) and 78% (18/23) respectively. CONCLUSIONS Primary lesion FDG visibility can be one of the indicators for choosing between oesophagectomy and ESD for resectable oesophageal SCCs.
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Affiliation(s)
- Masatoyo Nakajo
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
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50
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Omloo JMT, van Heijl M, Hoekstra OS, van Berge Henegouwen MI, van Lanschot JJB, Sloof GW. FDG-PET parameters as prognostic factor in esophageal cancer patients: a review. Ann Surg Oncol 2011; 18:3338-52. [PMID: 21537872 PMCID: PMC3192273 DOI: 10.1245/s10434-011-1732-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been used extensively to explore whether FDG Uptake can be used to provide prognostic information for esophageal cancer patients. The aim of the present review is to evaluate the literature available to date concerning the potential prognostic value of FDG uptake in esophageal cancer patients, in terms of absolute pretreatment values and of decrease in FDG uptake during or after neoadjuvant therapy. METHODS A computer-aided search of the English language literature concerning esophageal cancer and standardized uptake values was performed. This search focused on clinical studies evaluating the prognostic value of FDG uptake as an absolute value or the decrease in FDG uptake and using overall mortality and/or disease-related mortality as an end point. RESULTS In total, 31 studies met the predefined criteria. Two main groups were identified based on the tested prognostic parameter: (1) FDG uptake and (2) decrease in FDG uptake. Most studies showed that pretreatment FDG uptake and postneoadjuvant treatment FDG uptake, as absolute values, are predictors for survival in univariate analysis. Moreover, early decrease in FDG uptake during neoadjuvant therapy is predictive for response and survival in most studies described. However, late decrease in FDG uptake after completion of neoadjuvant therapy was predictive for pathological response and survival in only 2 of 6 studies. CONCLUSIONS Measuring decrease in FDG uptake early during neoadjuvant therapy is most appealing, moreover because the observed range of values expressed as relative decrease to discriminate responding from nonresponding patients is very small. At present inter-institutional comparison of results is difficult because several different normalization factors for FDG uptake are in use. Therefore, more research focusing on standardization of protocols and inter-institutional differences should be performed, before a PET-guided algorithm can be universally advocated.
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Affiliation(s)
- J M T Omloo
- Department of Surgery, The Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
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