The clinical usefulness of FDG-PET / CT parameters for predicting prognosis of patients of superficial esophageal squamous cell carcinoma diagnosed on endoscopy.

Introduction: We focused on the usefulness of FDG-PET / CT parameters for the predicting prognosis of patients with superficial esophageal squamous cell carcinoma diagnosed by endoscopy.

Methods: A total of 74 patients with esophageal cancer which was diagnosed as superficial type on endoscopic examination were included in this retrospective cohort study. All patients were referred to Nagasaki University Hospital PET/molecular imaging center between 2010 to June 31^st 2021, and underwent FDG PET/CT scans. All the FDG PET/CT images are analyzed visually and quantitatively. For visual analysis, all the patients are classified into four categories (non-visible, faintly-visible, clearly-visible, and massively-visible) by two interpreters. Due to the small number of subjects, visual classification was re-grouped into two groups (defined it as FDG-positive, FDG-negative = None + faintly, FDG-positive = clearly + massively). For the quantitative analysis, using SUV=3.0 as a threshold, when a tumor has an SUVmax value over 3.0 the tumor was considered as FDG positive, if not classified as FDG-negative. The quantitative data analysis was calculated using the original FDG PET/CT images. To measure the performance of FDG PET/CT for the prediction of overall survival, we examined the medical record and survival of all the patients and Kaplan-Meier analysis was performed to assess differences in survival between groups. Wilcoxon test was used to show the difference in survival between the groups.

Results: The 74 patients were examined (mean age: 67.9 years; range between 41 and 83; men 57 and 17 women). When the patients are grouped with visual classification, FDG negative patients tend to show better prognosis than FDG positive patients, but did not reach significant difference (p=0.3222). When the patients are grouped with quantitative classification using SUVmax =3.0 as threshold, FDG negative patient showed significantly better prognosis than FDG- positive patients (p=0.0236). That may indicate with quantitative analysis groups with better prognosis should be more precisely separated than those with visual analysis. These findings indicate grouping with quantitative method is better than that with visual analysis method regarding patient prognosis assessment.

Conclusions: We analyzed the prognosis of superficial esophageal cancer concerning the<s> </s>FDG PET/CT finding. We found that FDG-negative patients have a better prognosis than FDG-positive patients who are diagnosed with superficial esophageal cancer using endoscopy. We also compared visual analysis and quantitative analysis of FDG PET/CT images and found quantitative analysis showed better results. FDG -PET/CT may provide powerful prognostic parameters even for superficial esophageal cancer.

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