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

    Tutkimustuotos: ArtikkeliTieteellinenvertaisarvioitu

    28 Sitaatiot (Scopus)

    Abstrakti

    <p>Background. <sup>[18F]</sup>fluorodeoxyglycose-Positron Emission Tomography/Computer Tomography ( <sup>[18F]</sup>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 <sup>[18F]</sup>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 <sup>[18F]</sup>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.</p>
    AlkuperäiskieliEnglanti
    Sivut636-644
    Sivumäärä9
    JulkaisuActa Oncologica
    Vuosikerta51
    Numero5
    DOI - pysyväislinkit
    TilaJulkaistu - 2012
    OKM-julkaisutyyppiA1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä

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