Locally advanced esophageal adenocarcinoma: Response to neoadjuvant chemotherapy and survival predicted by [18F]FDG-PET/CT

Juha T. Kauppi; Niku Oksala; Jarmo A. Salo; Heikki Helin; Lauri Karhumäki; Jukka Kemppainen; Eero I. Sihvo; Jari V. Räsänen

doi:10.3109/0284186x.2011.643822

Locally advanced esophageal adenocarcinoma: Response to neoadjuvant chemotherapy and survival predicted by [18F]FDG-PET/CT

Juha T. Kauppi, Niku Oksala, Jarmo A. Salo, Heikki Helin, Lauri Karhumäki, Jukka Kemppainen, Eero I. Sihvo, Jari V. Räsänen

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Abstract

Background. [18F]fluorodeoxyglycose-Positron Emission Tomography/Computer Tomography ( [18F]FDG-PET/CT) is commonly used in staging of locally advanced esophageal cancer. Its predictive value for response to neoadjuvant therapy and survival after multimodality therapy is controversial. Methods. Sixty-six consecutive patients with locally advanced adenocarcinoma of the esophagus or esophagogastric junction underwent surgery after neoadjuvant chemotherapy. Staging was done prospectively with [18F]FDG-PET/CT, before and after completion of neoadjuvant therapy. Pre- and post-therapy maximal standardized uptake values for the primary tumor (SUV1 and SUV2) were determined, and their relative change (SUVΔ%) calculated. Percentage change in SUV1 was compared with histopathologic response (HPR, complete or subtotal histologic remission), disease-free- (DFS) and overall survival (OS). Results. Resection with negative margins was achieved in 60 patients. HPR rate was 14 of 66 (21.2%). Median follow-up was 16 months (range 4-72). For all patients, OS probability at three years was 59% and DFS 50%. In receiver operating characteristics (ROC) analysis, HPR was optimally predicted by a > 67% change in baseline maximal SUV (sensitivity 79% and specificity 75%). In univariate survival analysis (Cox regression proportional hazards), HPR associated with improved DFS (HR 0.208, p 0.033) but not OS (HR 0.030, p 0.101), SUV % > 67% associated with improved OS (HR 0.249, p 0.027) and DFS (HR 0.383, p = 0.040). In a multivariate model (adjusted by age, sex, and ASA score), neither HPR nor SUVΔ% > 67% was predictive of improved OS and DFS. However, SUVΔ% as a continuous variable was an independent predictor of OS (HR 0.966, p <0.0001) or DFS (HR 0.973, p <0.0001). Conclusion. Our results support previous results showing that [18F]FDG-PET/CT can distinguish a group of patients with worse prognosis after neoadjuvant chemotherapy in adenocarcinoma of the esophagus or esophagogastric junction. This information could offer a new independent preoperative marker of prognosis.

Original language	English
Pages (from-to)	636-644
Number of pages	9
Journal	Acta Oncologica
Volume	51
Issue number	5
DOIs	https://doi.org/10.3109/0284186x.2011.643822
Publication status	Published - 2012
Publication type	A1 Journal article-refereed

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10.3109/0284186x.2011.643822

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@article{7b9e77bb49a641839e01aceec5380e30,

title = "Locally advanced esophageal adenocarcinoma: Response to neoadjuvant chemotherapy and survival predicted by [18F]FDG-PET/CT",

abstract = "Background. [18F]fluorodeoxyglycose-Positron Emission Tomography/Computer Tomography ( [18F]FDG-PET/CT) is commonly used in staging of locally advanced esophageal cancer. Its predictive value for response to neoadjuvant therapy and survival after multimodality therapy is controversial. Methods. Sixty-six consecutive patients with locally advanced adenocarcinoma of the esophagus or esophagogastric junction underwent surgery after neoadjuvant chemotherapy. Staging was done prospectively with [18F]FDG-PET/CT, before and after completion of neoadjuvant therapy. Pre- and post-therapy maximal standardized uptake values for the primary tumor (SUV1 and SUV2) were determined, and their relative change (SUVΔ%) calculated. Percentage change in SUV1 was compared with histopathologic response (HPR, complete or subtotal histologic remission), disease-free- (DFS) and overall survival (OS). Results. Resection with negative margins was achieved in 60 patients. HPR rate was 14 of 66 (21.2%). Median follow-up was 16 months (range 4-72). For all patients, OS probability at three years was 59% and DFS 50%. In receiver operating characteristics (ROC) analysis, HPR was optimally predicted by a > 67% change in baseline maximal SUV (sensitivity 79% and specificity 75%). In univariate survival analysis (Cox regression proportional hazards), HPR associated with improved DFS (HR 0.208, p 0.033) but not OS (HR 0.030, p 0.101), SUV % > 67% associated with improved OS (HR 0.249, p 0.027) and DFS (HR 0.383, p = 0.040). In a multivariate model (adjusted by age, sex, and ASA score), neither HPR nor SUVΔ% > 67% was predictive of improved OS and DFS. However, SUVΔ% as a continuous variable was an independent predictor of OS (HR 0.966, p <0.0001) or DFS (HR 0.973, p <0.0001). Conclusion. Our results support previous results showing that [18F]FDG-PET/CT can distinguish a group of patients with worse prognosis after neoadjuvant chemotherapy in adenocarcinoma of the esophagus or esophagogastric junction. This information could offer a new independent preoperative marker of prognosis.",

author = "Kauppi, {Juha T.} and Niku Oksala and Salo, {Jarmo A.} and Heikki Helin and Lauri Karhum{\"a}ki and Jukka Kemppainen and Sihvo, {Eero I.} and R{\"a}s{\"a}nen, {Jari V.}",

year = "2012",

doi = "10.3109/0284186x.2011.643822",

language = "English",

volume = "51",

pages = "636--644",

journal = "Acta Oncologica",

issn = "0284-186X",

publisher = "Taylor & Francis",

number = "5",

}

TY - JOUR

T1 - Locally advanced esophageal adenocarcinoma: Response to neoadjuvant chemotherapy and survival predicted by [18F]FDG-PET/CT

AU - Kauppi, Juha T.

AU - Oksala, Niku

AU - Salo, Jarmo A.

AU - Helin, Heikki

AU - Karhumäki, Lauri

AU - Kemppainen, Jukka

AU - Sihvo, Eero I.

AU - Räsänen, Jari V.

PY - 2012

Y1 - 2012

N2 - Background. [18F]fluorodeoxyglycose-Positron Emission Tomography/Computer Tomography ( [18F]FDG-PET/CT) is commonly used in staging of locally advanced esophageal cancer. Its predictive value for response to neoadjuvant therapy and survival after multimodality therapy is controversial. Methods. Sixty-six consecutive patients with locally advanced adenocarcinoma of the esophagus or esophagogastric junction underwent surgery after neoadjuvant chemotherapy. Staging was done prospectively with [18F]FDG-PET/CT, before and after completion of neoadjuvant therapy. Pre- and post-therapy maximal standardized uptake values for the primary tumor (SUV1 and SUV2) were determined, and their relative change (SUVΔ%) calculated. Percentage change in SUV1 was compared with histopathologic response (HPR, complete or subtotal histologic remission), disease-free- (DFS) and overall survival (OS). Results. Resection with negative margins was achieved in 60 patients. HPR rate was 14 of 66 (21.2%). Median follow-up was 16 months (range 4-72). For all patients, OS probability at three years was 59% and DFS 50%. In receiver operating characteristics (ROC) analysis, HPR was optimally predicted by a > 67% change in baseline maximal SUV (sensitivity 79% and specificity 75%). In univariate survival analysis (Cox regression proportional hazards), HPR associated with improved DFS (HR 0.208, p 0.033) but not OS (HR 0.030, p 0.101), SUV % > 67% associated with improved OS (HR 0.249, p 0.027) and DFS (HR 0.383, p = 0.040). In a multivariate model (adjusted by age, sex, and ASA score), neither HPR nor SUVΔ% > 67% was predictive of improved OS and DFS. However, SUVΔ% as a continuous variable was an independent predictor of OS (HR 0.966, p <0.0001) or DFS (HR 0.973, p <0.0001). Conclusion. Our results support previous results showing that [18F]FDG-PET/CT can distinguish a group of patients with worse prognosis after neoadjuvant chemotherapy in adenocarcinoma of the esophagus or esophagogastric junction. This information could offer a new independent preoperative marker of prognosis.

AB - Background. [18F]fluorodeoxyglycose-Positron Emission Tomography/Computer Tomography ( [18F]FDG-PET/CT) is commonly used in staging of locally advanced esophageal cancer. Its predictive value for response to neoadjuvant therapy and survival after multimodality therapy is controversial. Methods. Sixty-six consecutive patients with locally advanced adenocarcinoma of the esophagus or esophagogastric junction underwent surgery after neoadjuvant chemotherapy. Staging was done prospectively with [18F]FDG-PET/CT, before and after completion of neoadjuvant therapy. Pre- and post-therapy maximal standardized uptake values for the primary tumor (SUV1 and SUV2) were determined, and their relative change (SUVΔ%) calculated. Percentage change in SUV1 was compared with histopathologic response (HPR, complete or subtotal histologic remission), disease-free- (DFS) and overall survival (OS). Results. Resection with negative margins was achieved in 60 patients. HPR rate was 14 of 66 (21.2%). Median follow-up was 16 months (range 4-72). For all patients, OS probability at three years was 59% and DFS 50%. In receiver operating characteristics (ROC) analysis, HPR was optimally predicted by a > 67% change in baseline maximal SUV (sensitivity 79% and specificity 75%). In univariate survival analysis (Cox regression proportional hazards), HPR associated with improved DFS (HR 0.208, p 0.033) but not OS (HR 0.030, p 0.101), SUV % > 67% associated with improved OS (HR 0.249, p 0.027) and DFS (HR 0.383, p = 0.040). In a multivariate model (adjusted by age, sex, and ASA score), neither HPR nor SUVΔ% > 67% was predictive of improved OS and DFS. However, SUVΔ% as a continuous variable was an independent predictor of OS (HR 0.966, p <0.0001) or DFS (HR 0.973, p <0.0001). Conclusion. Our results support previous results showing that [18F]FDG-PET/CT can distinguish a group of patients with worse prognosis after neoadjuvant chemotherapy in adenocarcinoma of the esophagus or esophagogastric junction. This information could offer a new independent preoperative marker of prognosis.

U2 - 10.3109/0284186x.2011.643822

DO - 10.3109/0284186x.2011.643822

M3 - Article

AN - SCOPUS:84862093870

SN - 0284-186X

VL - 51

SP - 636

EP - 644

JO - Acta Oncologica

JF - Acta Oncologica

IS - 5

ER -

Locally advanced esophageal adenocarcinoma: Response to neoadjuvant chemotherapy and survival predicted by [18F]FDG-PET/CT

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