Abstract
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Objectives It has been suggested that FDG PET has predictive value for the prognosis of treated esophageal carcinoma. However, the studies reported in the literature have shown discordant results. The aim of this study was to determine whether pretherapy quantitative metabolic parameters correlate with patients’ outcome.
Methods 67 patients with a histological diagnosis of esophageal squamous cell carcinoma were included in this study. Each patient underwent FDG PET (4.5 MBq/kg) before chemo radiotherapy (CRT), following Herskovic’s protocol. The quantitative analysis was carried out using the following parameters: age, weight loss, location, N stage, OMS performance status, MTVp and MTVp’ (metabolic tumor volume determined by 2 different physicians), MTV40% (volume for a threshold of 40% of SUVmax), SUVmax, SUVmean and TLG.
Results MTVp and MTV40% were highly correlated (Pearson index 0.92, Spearman index 0.86). SUVmeanp and SUVmean40% were also correlated (Pearson index 0.86, Spearman index 0.79). TLGp and TLG40% were correlated (Pearson index 0.98, Spearman index 0.96). MTVp and MTVp’ were highly correlated. Multivariate analysis for disease-free survival showed that a larger MTVp was associated with a shortened DFS (p=0.0038) and that a high SUVmax was associated with an increased DFS (p=0.0219). Other parameters were not statistically significant. Multivariate analysis for overall survival showed that a larger MTVp was associated with a shortened OS (p=0.0139), and that a tumor developed from the distal oesophagus was associated with an increased OS (p=0.0046). Other parameters were not statistically significant.
Conclusions Metabolic tumor volume is a major prognostic factor for DFS and OS in patients with esophageal squamous cell carcinoma. High SUVmax values were paradoxically associated with longer survival. Location also appears to interfere with the prognosis.
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