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Value of a 18F-FDG PET/CT Semi-quantitative Parameter (SUVmax) in Predicting the Survival of Patients with Esophageal Cancer Subtypes. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-128737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan is employed for initial staging and restaging of esophageal cancer patients. Objectives: The present study aimed to assess the value of a semi-quantitative parameter of 18F-FDG PET/CT scan, that is, maximum standardized uptake value (SUVmax), to determine its correlation with patient survival in two subtypes of esophageal cancer, including squamous cell carcinoma (SCC) and adenocarcinoma. Patients and Methods: This cross-sectional study was performed on patients with esophageal SCC and adenocarcinoma, undergoing 18F-FDG PET/CT scan for initial staging before any treatment. The 18F-FDG PET/CT semi-quantitative parameter (SUVmax) was determined by reviewing the PET/CT images. The patients were reevaluated using 18F-FDG PET/CT scan for restaging within 12 - 24 months. Results: No significant difference was observed in the SUVmax values of the primary tumor, metastatic lymph nodes, or distant metastasis between the adenocarcinoma and SCC groups, regardless of response to treatment. Similarly, no significant association was found between the short-term survival of patients with adenocarcinoma and the SUVmax values of the primary tumor, metastatic lymph nodes, or distant metastasis. Based on the survival curve, one- and two-year survival rates were estimated at 75% and 63.9% in patients with SCC and at 80% and 60% in patients with adenocarcinoma, respectively. In the SCC group, a significantly higher SUVmax was detected in deceased patients with distant metastatic lesions compared to cancer survivors. According to the area under the ROC curve, the SUVmax of metastatic lesions showed high potential for predicting the mortality of SCC patients. Conclusion: The assessment of SUVmax in distant metastatic lesions by 18F-FDG-PET/CT may help predict the survival of patients with esophageal SCC. However, 18F-FDG-PET/CT findings were not associated with the survival of esophageal adenocarcinoma; therefore, further evaluations on a larger sample size and a longer follow-up are required.
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Prognostic Value of [18F]-FDG PET/CT Radiomics Combined with Sarcopenia Status among Patients with Advanced Gastroesophageal Cancer. Cancers (Basel) 2022; 14:cancers14215314. [PMID: 36358733 PMCID: PMC9658937 DOI: 10.3390/cancers14215314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
We investigated, whether 18[18F]-FDG PET/CT-derived radiomics combined with sarcopenia measurements improves survival prognostication among patients with advanced, metastatic gastroesophageal cancer. In our study, 128 consecutive patients with advanced, metastatic esophageal and gastroesophageal cancer (n = 128; 26 females; 102 males; mean age 63.5 ± 11.7 years; age range: 29−91 years) undergoing 18[18F]-FDG PET/CT for staging between November 2008 and December 2019 were included. Segmentation of the primary tumor and radiomics analysis derived from PET and CT images was performed semi-automatically with a commonly used open-source software platform (LIFEX, Version 6.30, lifexsoft.org). Patients’ nutritional status was determined by measuring the skeletal muscle index (SMI) at the level of L3 on the CT component. Univariable and multivariable analyses were performed to establish a survival prediction model including radiomics, clinical data, and SMI score. Univariable Cox proportional hazards model revealed ECOG (<0.001) and bone metastasis (p = 0.028) to be significant clinical parameters for overall survival (OS) and progression free survival (PFS). Age (p = 0.017) was an additional prognostic factor for OS. Multivariable analysis showed improved prognostication for overall and progression free survival when adding sarcopenic status, PET and CT radiomics to the model with clinical parameters only. PET and CT radiomics derived from hybrid 18[18F]-FDG PET/CT combined with sarcopenia measurements and clinical parameters may improve survival prediction among patients with advanced, metastatic gastroesophageal cancer.
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Lee S, Choi Y, Park G, Jo S, Lee SS, Park J, Shim HK. 18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy. Technol Cancer Res Treat 2021; 20:15330338211024655. [PMID: 34227434 PMCID: PMC8264725 DOI: 10.1177/15330338211024655] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower (P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV (P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS (P = 0.002) and OS (P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS (P = 0.009) and OS (P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS (P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.
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Affiliation(s)
- Seokmo Lee
- Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Yunseon Choi
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Busan, Korea
| | - Geumju Park
- Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sunmi Jo
- Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sun Seong Lee
- Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Jisun Park
- Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Hye-Kyung Shim
- Department of Nuclear Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Jinnouchi H, Yamashita H, Kiritoshi T, Miki Y, Katano A, Nakagawa K, Abe O. Prognostic value of pre-treatment maximum standardized uptake value and CRP in radiotherapy of esophageal cancer. Mol Clin Oncol 2021; 15:146. [PMID: 34094544 DOI: 10.3892/mco.2021.2308] [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: 08/21/2020] [Accepted: 04/01/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the prognostic value of the pre-treatment maximum standardized uptake value (SUVmax) and CRP in patients who underwent chemoradiotherapy for esophageal squamous cell carcinoma. A retrospective review of 69 consecutive patients with esophageal cancer who underwent concurrent chemoradiotherapy between 2013 and 2016 was performed. The total radiotherapy doses were 50, 50.4 or 60 Gy. The endpoints of the present study were overall survival (OS) and disease-free survival (DFS). The median follow-up for censored cases was 45.7 months. In 56 patients, 18F-fluorodeoxyglucose positron emission tomography was performed within 1 month prior to chemoradiotherapy. Data on CRP within 1 month prior to chemoradiotherapy were available for all patients. In the group of SUVmax >12.85, the rates of 2-year OS and DFS were 49.0 and 35.7%, respectively. In the group of SUVmax ≤12.85, these values were 72.4 and 67.1%, respectively (P=0.048 and P=0.057, respectively). In the group of CRP ≥1 mg/dl, these percentages were 38.5 and 25.0%, respectively. In the group of CRP <1 mg/dl, these rates were 71.2 and 59.7%, respectively (P=0.013 and P<0.001, respectively). A multivariate analysis revealed that pre-treatment serum CRP levels remained an independent prognostic factor for both OS and DFS [OS: hazard ratio (HR), 0.25, P=001; DFS: HR, 0.28, P=0.005]. In conclusion, high SUVmax was associated with lower OS, while high CRP was associated with lower OS and DFS.
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Affiliation(s)
- Haruka Jinnouchi
- Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tomoki Kiritoshi
- Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yosuke Miki
- Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Serralheiro P, Rankin A, Clark A, Holyoake D, Cheong E. Pre- and postoperative prognostic factors for resectable esophageal adenocarcinoma. Surg Oncol 2020; 35:132-138. [PMID: 32871548 DOI: 10.1016/j.suronc.2020.08.026] [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: 10/27/2019] [Revised: 05/22/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prognostication for esophageal cancer has traditionally relied on postoperative tissue specimens. This study aimed to use a histologically homogenous cohort to investigate the relationship between clinical, pathological or radiological variables and overall survival in patients undergoing esophagectomy for adenocarcinoma. METHODS A single-centre study of patients who underwent esophagectomy for adenocarcinoma over 10 years in a tertiary centre was performed. By regression analysis, variables available preoperatively and postoperatively were studied for prognostication. The primary outcome was overall survival. RESULTS 254 cases were analyzed. Over a median follow-up period of 31.8 months (IQR = 42.5), overall survival was 51.5 months (95% confidence interval: 33.0-69.9). According to hazard ratios (HR) for all-cause death, adverse prognostic factors included: a higher postoperative N-stage (HR ≥ 1.29; p ≤ 0.024), histopathological tumor length ≥25 mm (HR = 2.04; p = 0.03), poorer tumor differentiation (HR ≥ 2.86; p ≤ 0.042), and R1 status (HR = 2.33; p = 0.02). A lymph node yield ≥35 was a favorable prognostic factor (HR = 0.022; p < 0.001). Demographic and radiological variables, preoperative TNM stages, postoperative T-stage, and neoadjuvant/adjuvant treatment were not associated with overall survival. CONCLUSIONS This study identifies several postoperatively factors which are available for the prognostication and identifies factors that should not be used to exclude patients from curative surgery.
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Affiliation(s)
- Pedro Serralheiro
- Faculty of Health Sciences, CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6201-506, Covilhã, Portugal.
| | - Adeline Rankin
- Department of Upper Gastrointestinal Surgery, Norfolk & Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - Allan Clark
- Norwich Medical School, University of East Anglia, NR4 7TJ, Norwich, UK.
| | - Daniel Holyoake
- Department of Oncology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - Edward Cheong
- Department of Upper Gastrointestinal Surgery, Norfolk & Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
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Miyawaki Y, Sato H, Fujiwara N, Oya S, Sugita H, Hirano Y, Yamane T, Sakuramoto S, Okamoto K, Yamaguchi S, Koyama I. Association of the primary tumor's SUVmax with survival after surgery for clinical stage IA esophageal cancer: a single-center retrospective study. Int J Clin Oncol 2019; 25:561-569. [PMID: 31867680 DOI: 10.1007/s10147-019-01606-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Compared to other esophageal cancers, clinical stage IA esophageal cancer generally has a good prognosis, although a subgroup of patients has a poor prognosis. Unfortunately, clinical diagnoses of invasion depth or lymph node metastasis are not always accurate, which make it difficult to identify patients with a high risk of postoperative recurrence using the tumor-node-metastasis staging system. Fluorodeoxyglucose-positron emission tomography may help guide the identification of malignant tumors and the evaluation of their malignant grade based on glucose metabolism. We aimed to evaluate the association between pre-operative fluorodeoxyglucose-positron emission tomography findings and the postoperative prognosis of patients with clinical stage IA esophageal cancer. METHODS This single-center retrospective study evaluated pre-esophagectomy fluorodeoxyglucose-positron emission tomography findings from 38 patients with clinical stage IA esophageal cancer. Receiver operating characteristic curve analysis was performed to evaluate the prognostic significance of the primary tumor having low and high SUVmax values (cut-off: 3.56). RESULTS Overall survival (log-rank p = 0.034) and progression-free survival (log-rank p = 0.008) were significantly different between the groups with low SUVmax values (n = 18) and high SUVmax values (n = 20). Furthermore, the primary tumor's SUVmax value was related to pathological vascular invasion (p = 0.045) and distant metastasis (p = 0.042). CONCLUSION The SUVmax of the primary tumor is a predictor of postoperative survival for clinical stage IA esophageal cancer. Thus, using fluorodeoxyglucose-positron emission tomography to evaluate the primary tumor's glucose metabolism may reflect the tumor's grade and potentially compensate for inaccuracies in tumor-node-metastasis staging.
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Affiliation(s)
- Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan.
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Naoto Fujiwara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Tomohiko Yamane
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Kojun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Isamu Koyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
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Does PET/CT give incremental staging information in cancer oesophagus compared to CECT? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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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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Hu J, Zhu D, Yang Y. Diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for preoperative lymph node metastasis of esophageal cancer: A meta-analysis. Medicine (Baltimore) 2018; 97:e13722. [PMID: 30558091 PMCID: PMC6319779 DOI: 10.1097/md.0000000000013722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/22/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We determined the value of F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) for the assessment of preoperative lymph node metastases in patients with esophageal cancer. METHODS We searched electronic database indexes for articles on PET/CT assessment of lymph node status. Information including true positives, false positives, false negatives, and true negatives was obtained. Based on these data, the pooled sensitivity, specificity, diagnostic odds ratio, and likelihood ratio were calculated using bivariate models and receiver operating characteristic curves (ROCs) were drawn. RESULTS Patients without neoadjuvant treatment had a pooled sensitivity and specificity (95% confidence interval [CI]) of 0.57 (0.45-0.69) and 0.91 (0.85-0.95), respectively. Patients who received neoadjuvant treatment had a pooled sensitivity and specificity of 0.53 (0.35-0.70) and 0.96 (0.86-0.99), respectively. CONCLUSIONS The PET/CT has a high diagnostic specificity but its diagnostic sensitivity is low; thus, its diagnosis findings cannot accurately reflect the lymph node status.
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Affiliation(s)
- Jingfeng Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan 450052, China
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Altazi BA, Fernandez DC, Zhang GG, Hawkins S, Naqvi SM, Kim Y, Hunt D, Latifi K, Biagioli M, Venkat P, Moros EG. Investigating multi-radiomic models for enhancing prediction power of cervical cancer treatment outcomes. Phys Med 2018; 46:180-188. [PMID: 29475772 DOI: 10.1016/j.ejmp.2017.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/09/2017] [Accepted: 10/14/2017] [Indexed: 12/22/2022] Open
Abstract
Quantitative image features, also known as radiomic features, have shown potential for predicting treatment outcomes in several body sites. We quantitatively analyzed 18Fluorine-fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) uptake heterogeneity in the Metabolic Tumor Volume (MTV) of eighty cervical cancer patients to investigate the predictive performance of radiomic features for two treatment outcomes: the development of distant metastases (DM) and loco-regional recurrent disease (LRR). We aimed to fit the highest predictive features in multiple logistic regression models (MLRs). To generate such models, we applied backward feature selection method as part of Leave-One-Out Cross Validation (LOOCV) within a training set consisting of 70% of the original patient cohort. The trained MLRs were tested on an independent set consisted of 30% of the original cohort. We evaluated the performance of the final models using the Area under the Receiver Operator Characteristic Curve (AUC). Accordingly, six models demonstrated superior predictive performance for both outcomes (four for DM and two for LRR) when compared to both univariate-radiomic feature models and Standard Uptake Value (SUV) measurements. This demonstrated approach suggests that the ability of the pre-radiochemotherapy PET radiomics to stratify patient risk for DM and LRR could potentially guide management decisions such as adjuvant systemic therapy or radiation dose escalation.
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Affiliation(s)
- Baderaldeen A Altazi
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA; King Fahad Specialist Hospital at Dammam, Saudi Arabia.
| | - Daniel C Fernandez
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
| | - Geoffrey G Zhang
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
| | - Samuel Hawkins
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
| | - Syeda M Naqvi
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
| | - Youngchul Kim
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
| | - Dylan Hunt
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
| | - Kujtim Latifi
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
| | | | - Puja Venkat
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
| | - Eduardo G Moros
- H. L. Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
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Correlation of pretreatment 18F-FDG uptake with clinicopathological factors and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma. Nucl Med Commun 2017; 37:689-98. [PMID: 27244584 PMCID: PMC4885594 DOI: 10.1097/mnm.0000000000000496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives The aim of this study is to determine the correlation of pretreatment fluorine-18 fluorodeoxyglucose uptake with clinicopathological factors and its prognostic value in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). Patients and methods A cohort of 162 patients with newly diagnosed DLBCL who had undergone pretreatment PET/computed tomography was retrospectively reviewed. The relationship of pretreatment maximum standard uptake value (SUVmax) with clinical factors, molecular markers, and efficacy was evaluated. The value of SUVmax in predicting progression-free survival (PFS) and overall survival was analyzed. Results In all, 72.9% of the patients received R-CHOP treatment; the rest received CHOP chemotherapy. The median follow-up duration was 30 months (range, 4–124 months). The median SUVmax was 12.2 (range, 1.7–42.7). SUVmax between groups differed significantly with respect to each of International Prognostic Index (IPI) factors, except for age and performance status. High SUVmax was associated with high Ki-67 and Glut-3 protein expression, but not with Glut-1. Complete remission rate differed significantly between the low (SUVmax≤9.0) and the high SUVmax (SUVmax>9.0) groups (91.7 vs. 61.1%, P=0.000). Patients with low SUVmax showed favorable survival (3-year PFS: 92.2 vs. 63.6%, P=0.000; 3-year overall survival: 95.5 vs. 78.3%, P=0.003). On multivariate analyses, SUVmax predicted PFS independent of revised-IPI (SUVmax: P=0.011, hazard ratio 4.784; revised-IPI: P=0.004, hazard ratio 2.551). Conclusion Pretreatment SUVmax was associated with clinicopathological factors, efficacy, and survival outcome. A novel prognostic model on the basis of IPI score/pretreatment SUVmax might be useful for risk stratification of patients with newly diagnosed DLBCL Video abstract: http://links.lww.com/NMC/A55.
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Vatankulu B, Şanlı Y, Kaytan Sağlam E, Kuyumcu S, Özkan ZG, Yılmaz E, Purisa S, Adalet I. Does Metastatic Lymph Node SUVmax Predict Survival in Patients with Esophageal Cancer? Mol Imaging Radionucl Ther 2016; 24:120-7. [PMID: 27529887 PMCID: PMC4745404 DOI: 10.4274/mirt.36744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: We aimed to investigate the SUVmax of primary tumor and metastatic lymph node in predicting survival in patients with esophageal cancer. Methods: We retrospectively analyzed patients with esophageal cancer between 2009 and 2011 who had FDG positron-emission tomography (PET)/computed tomography (CT). All patients were followed-up to 2013. Clinical staging, SUVmax of primary tumor and metastatic lymph node were evaluated. Results: One hundred seven patients were included in the study. All patients were followed-up between 2 and 49 months. The mean SUVmax of primary tumor and metastatic lymph node were 19.3±8.8 and 10.4±9.1, respectively. Metastatic lymph node SUVmax had an effect in predicting survival whereas primary tumor SUVmax did not have an effect (p=0.014 and p=0.262, respectively). Multivariate Cox regression analysis showed that clinical stage of the disease was the only independent factor predicting survival (p=0.001). Conclusion: Among patients with esophageal cancer, the value of primary tumor SUVmax did not have an effect on survival. Clinical stage assessed with FDG PET/CT imaging was found to predict survival in esophageal carcinoma. Additionally, lymph node SUVmax was identified as a new parameter in predicting survival in the present study.
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Affiliation(s)
- Betül Vatankulu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey Phone: +90 212 414 20 00 E-mail:
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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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Chhabra A, Ong LT, Kuk D, Ku G, Ilson D, Janjigian YY, Wu A, Schöder H, Goodman KA. Prognostic significance of PET assessment of metabolic response to therapy in oesophageal squamous cell carcinoma. Br J Cancer 2015; 113:1658-65. [PMID: 26657654 PMCID: PMC4702001 DOI: 10.1038/bjc.2015.416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/08/2015] [Accepted: 11/04/2015] [Indexed: 12/04/2022] Open
Abstract
Objectives: The role of maximum standard uptake value (SUVmax) at baseline and after induction chemotherapy (CT) on positron emission tomography (PET) as an imaging biomarker has not been well established in oesophageal squamous cell carcinoma (SCC). In this retrospective analysis, we investigated the prognostic significance of various PET metrics in oesophageal SCC patients treated with induction chemotherapy followed by concurrent chemoradiotherapy (CRT). Methods: A total of 57 patients were treated with CRT; 52 patients received induction chemotherapy and 10 patients underwent surgery following CRT. Scans were independently analysed by a nuclear medicine physician blinded to patient outcome. Using region of interest analysis, SUVmax and metabolic tumour volume (MTV) were calculated for the index lesion and lymph node metastases in each patient. Kaplan–Meier analysis was used to evaluate overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). Cox proportional hazards regression was used to assess correlation between outcomes and PET metrics. Results: Median follow-up for those who are alive was 4.4 years, with a median survival for all patients of 2.9 years. The 3-year OS, DFS, DMFS and LRFS rates were 47, 40, 44 and 36%, respectively. Using a pre-established cutoff of a 35% decrease in SUVmax from baseline to post-induction PET, 3-year OS for responders (⩾35% decrease from baseline) was 64%, whereas non-responders (<35% decrease from baseline) had a 3-year OS of 15% (P=0.004). Conclusions: The pre-specified 35% decrease in SUVmax after induction chemotherapy was prognostic for OS. Baseline and post-induction PET metrics provide prognostic information for oesophageal SCC.
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Affiliation(s)
- Arpit Chhabra
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Leonard T Ong
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Deborah Kuk
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Geoffrey Ku
- Gastrointestinal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David Ilson
- Gastrointestinal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yelena Y Janjigian
- Gastrointestinal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Abraham Wu
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Kwee RM, Marcus C, Sheikhbahaei S, Subramaniam RM. PET with Fluorodeoxyglucose F 18/Computed Tomography in the Clinical Management and Patient Outcomes of Esophageal Cancer. PET Clin 2015; 10:197-205. [DOI: 10.1016/j.cpet.2014.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kim JJ, Park JK, Moon SW. Usefulness of positron emission tomography-computed tomography in pre-operative evaluation of intra-thoracic esophageal cancer. Thorac Cancer 2015; 6:687-94. [PMID: 26557905 PMCID: PMC4632919 DOI: 10.1111/1759-7714.12237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/27/2014] [Indexed: 12/14/2022] Open
Abstract
Background The purpose of the study was to clarify the usefulness of positron emission tomography-computed tomography (PET-CT) for pre-operative evaluation of intra-thoracic esophageal cancer, especially in terms of regional lymph node status. Methods Medical records of 93 consecutive cases from July 2007 to October 2012 were retrospectively reviewed. All patients underwent curative and complete esophagectomies for intra-thoracic esophageal cancer. We compared pre-operative maximum standard uptake values (SUVmax) of esophageal tumors and regional lymph nodes (LN) with other variables (chronic obstructive pulmonary disease, history of previous other primary cancer, gender, differentiation, and neoadjuvant therapy). In addition, the SUVmax of tumors and LNs were analyzed with pathologic findings. Results There was no significant difference of each tumor and LN SUVmax according to factors including chronic lung disease, age, history of previous other cancer, differentiation, and gender. Pre-operative evaluations by PET-CT were not accurate (tumor sensitivity 76.4%, specificity 25%; LN sensitivity 45.2%, specificity 54.8%). Receiver operating characteristic analysis showed that LN metastasis could not be appropriately diagnosed with SUVmax (P = 0.871). There was no difference in SUVmax between pathologically positive and negative LN subgroups. Tumor SUVmax correlated with the progression of esophageal cancer in patients without neoadjuvant therapy (P < 0.001). However, LN SUVmax had no correlation with overall pathologic stage. After neoadjuvant therapy, there were significant decreases in SUVmax in both pathologically positive and negative LN subgroups (P = 0.043, P = 0.008). Conclusion Surgery should not be withheld in N-stage according to PET-CT findings and carefully considered in conjunction with other conditions.
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Affiliation(s)
- Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine Uijeongbu, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine Seoul, Korea
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Guerrero M, Tan S, Lu W. Radiobiological Modeling Based on 18F-Fluorodeoxyglucose Positron Emission Tomography Data for Esophageal Cancer. JOURNAL OF NUCLEAR MEDICINE & RADIATION THERAPY 2015; 5. [PMID: 25580368 PMCID: PMC4286330 DOI: 10.4172/2155-9619.1000190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background We investigated the relationship of standardized uptake values (SUVs) to radiobiological parameters, such a 25 s tumor control probability (TCP), to allow for quantitative prediction of tumor response based on SUVs from 18F fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) before and after treatment for esophageal cancer. Methods We analyzed data from 20 esophageal cancer patients treated with chemoradiotherapy (CRT) followed by surgery. Tumor pathologic response to CRT was assessed in surgical specimens. Patients underwent 18F-FDG PET imaging before and after CRT. Rigid image registration was performed between both images. Because TCP in a heterogeneous tumor is a function of average cell survival, we modeled TCP as a function of <SUVR>, a possible surrogate for average cell survival (<SUVR>=<SUVafter/SUVbefore>). TCP was represented by a sigmoid function with two parameters: SUVR50, the <SUVR> at which TCP=0.5, and γ50, the slope of the curve at SUVR50. The two parameters and their confidence intervals (CIs) were estimated using the maximum-likelihood method. The correlation between SUV before CRT and SUV change <SUVbefore – SUVafter> was also studied. Results A TCP model as a function of SUV before and after treatment was developed for esophageal cancer patients. The maximum-likelihood estimate of SUVR50 was 0.47 (90% CI, 0.30-0.61) and for γ50 was 1.62 (90% CI, 0-4.2). High initial SUV and larger metabolic response (larger <SUVbefore –SUVafter>) were correlated, and this correlation was stronger among responders. Conclusions Our TCP model indicates that <SUVafter/SUVbefore> is a possible surrogate for cell survival in esophageal cancer patients. Although CIs are large as a result of the small patient sample, parameters for a TCP curve can be derived and an individualized TCP can be calculated for future patients. Initial SUV does not predict response, whereas a correlation is found between surrogates for initial tumor burden and cell kill during therapy.
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Affiliation(s)
- Mariana Guerrero
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, 21201, USA
| | - Shan Tan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, 21201, USA ; Department of Intelligent Science and Technology, School of Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Lu
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, 21201, 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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Algin E, Ozet A, Gumusay O, Cetin B, Akdemir UO, Benekli M, Coskun U, Uner A, Kapucu O, Buyukberber S. Association between survival and maximum standardized uptake value of liver metastases detected by 18-fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography in patients with adenocarcinoma of unknown primary origin. Ann Nucl Med 2014; 28:891-6. [DOI: 10.1007/s12149-014-0896-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/03/2014] [Indexed: 12/22/2022]
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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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Evaluating the role of fluorodeoxyglucose positron emission tomography-computed tomography in multi-disciplinary team recommendations for oesophago-gastric cancer. Br J Cancer 2013; 109:1445-50. [PMID: 23963146 PMCID: PMC3776989 DOI: 10.1038/bjc.2013.478] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/15/2013] [Accepted: 07/25/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND National guidelines recommend that fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) is performed in all patients being considered for radical treatment of oesophageal or oesophago-gastric cancer without computerised tomography scan (CTS) evidence of metastasis. Guidance also mandates that all patients with cancer have treatment decisions made within the context of a multi-disciplinary team (MDT) meeting. Little is known, however, about the influence of PET-CT on decision making within MDTs. The aim of this study was to assess the role of PET-CT in oesophago-gastric cancer on MDT decision making. METHODS A retrospective analysis of a prospectively held database of all patients with biopsy-proven oesophageal or oesophago-gastric cancer discussed by a specialist MDT was interrogated. Patients selected for radical treatment without CTS evidence of M1 disease were identified. The influence of PET-CT on MDT decision making was examined by establishing whether the PET-CT confirmed CTS findings of M0 disease (and did not change the patient staging pathway) or whether the PET-CT changed the pathway by showing unsuspected M1 disease, refuting CTS suspicious metastases, or identifying another lesion (needing further investigation). RESULTS In 102 MDT meetings, 418 patients were discussed, of whom 240 were initially considered for radical treatment and 238 undergoing PET-CT. The PET-CT confirmed CTS findings for 147 (61.8%) and changed MDT recommendations in 91 patients (38.2%) by (i) identifying M1 disease (n=43), (ii) refuting CTS suspicions of M1 disease (n=25), and (iii) identifying new lesions required for investigations (n=23). CONCLUSION The addition of PET-CT to standard staging for oesophageal cancer led to changes in MDT recommendations in 93 (38.2%) patients, improving patient selection for radical treatment. The validity of the proposed methods for evaluating PET-CT on MDT decision making requires more work in other centres and teams.
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Cheung GSM. Contribution of PET–CT in radiotherapy planning of oesophageal carcinoma: A review. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2013.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Chowdhury F, Radhakrishna G, Godfrey E. Commentary on: Prognostic significance of 18-FDG PET/CT and EUS-defined tumour characteristics in patients with oesophageal cancer. Clin Radiol 2013; 68:338-9. [DOI: 10.1016/j.crad.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/04/2012] [Indexed: 12/22/2022]
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Wang WP, Wang KN, Chen LQ. PET Could Predict Response to Neoadjuvant Therapy and Long-Term Survival of Patients with Esophageal Cancer. World J Surg 2012; 37:930-1. [DOI: 10.1007/s00268-012-1825-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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