Relative metabolic tumor burden is associated with residual lymph node status after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer
Relative metabolic tumor burden is associated with residual lymph node status after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer
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DOI：
10.1007/s10388-020-00768-z
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发表时间：
2020-07-31
期刊：
影响因子：
2.4
通讯作者：
Tan, Lijie
中科院分区：
文献类型：
--
作者：
Lin, Dong;Liu, Guobing;Tan, Lijie
背景：在可切除的局部晚期食道癌中，新辅助放化疗结合手术的生存效益有限。然而，结节受累的阈值尚不清楚。方法对接受非CRT和手术患者的18F-FDGPET/CT代谢参数进行回顾性测量和计算。参数包括全身代谢性肿瘤体积(MTVwb)、原发灶肿瘤体积(MTVp)、淋巴结代谢性肿瘤体积(MTVn)和相对代谢性肿瘤负荷(R-MTb，定义为MTVwb/MTVp的比值)。结果67例患者入选本研究。阈值分别为100.00.0、3.5、4.0、4.5和5.0的MTVP与临床T分期(Spearman‘s等级相关系数，P均为0.0001)和临床肿瘤长度分类(Spearman’s等级相关系数，P均为0，R-MTB和GT；5.0%)显著相关。NCRT后，43例(64.2%)患者达到了ypN0。单因素和多因素回归分析显示，R-MTB(106.00%)是与PYN+状态相关的独立因素(OR 0.093，95%CI 0.023~0.378，P=0.001)。结论初步研究表明，食道癌的临床淋巴结类型具有很大的异质性。提示R-MTB与局部晚期食道癌新辅助放化疗后的PYN状态显著相关。这些发现和适应症需要在一项有大量患者队列的前瞻性研究中进一步研究。
Background Extended lymph node involvement could indicate limited survival benefit from neoadjuvant chemoradiotherapy with surgery in resectable locally advanced esophageal cancer. However, the threshold of node involvement is unclear. Methods We retrospectively measured and calculated metabolic parameters derived from(18)F-FDG PET/CT of the patients with nCRT and surgery. The parameters included metabolic tumor volume of the whole body (MTVwb), of the primary tumor (MTVp), of the lymph nodes (MTVn), and relative metabolic tumor burden (R-MTB, defined as the ratio of MTVwb and MTVp). Results A total of 67 patients were enrolled in the study. The MTVp with thresholds as 3.0, 3.5, 4.0, 4.5 and 5.0 were significantly correlated with clinical T categories (Spearman's rank correlation coefficient, allP < 0.0001) and clinical tumor length categories (Spearman's rank correlation coefficient, allP 0, R-MTB > 100.00%). After nCRT, 43 (64.2%) patients achieved ypN0. The univariate and multivariate regression revealed that R-MTB ( 106.00%) was an independent factor associated with ypN + status (OR 0.093, 95%CI 0.023-0.378,P = 0.001). Conclusion The preliminary study revealed a great heterogeneity in clinical lymph node categories in esophageal cancer. It suggested that R-MTB was significantly associated with ypN status after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer. The findings with the indications needed to be further studied in a prospective study with a large patient cohort.