Total Lesion Glycolysis Assessment Identifies a Patient Fraction With a High Cure Rate Among Esophageal Adenocarcinoma Patients Treated With Definitive Chemoradiation
Total Lesion Glycolysis Assessment Identifies a Patient Fraction With a High Cure Rate Among Esophageal Adenocarcinoma Patients Treated With Definitive Chemoradiation
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DOI：
10.1097/sla.0000000000003228
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发表时间：
2020-08-01
影响因子：
9
通讯作者：
Ajani, Jaffer A.
中科院分区：
文献类型：
--
作者：
Harada, Kazuto;Wu, Carol C.;Ajani, Jaffer A.
目的：我们旨在确定肿瘤代谢是否可以预测接受明确放化疗的L-EAC患者的治愈。背景数据总结：不能手术的局限性食管腺癌（L-EAC）患者通常接受明确的放化疗;然而，缺乏生物标志物和/或影像学变量来确定治愈。研究方法：对2002年3月至2015年4月期间德克萨斯大学MD安德森癌症中心（美国德克萨斯州）胃肠肿瘤内科前瞻性维护的EAC数据库中266例接受放化疗但未接受手术的L-EAC患者进行了分析。评估正电子发射断层扫描数据的最大标准化摄取值（SUVmax）和总病变糖酵解（TLG）。结果：266例患者中，253例（95%）为男性;中位年龄为67岁（范围20-91岁），153例为低分化L-EAC。中位SUV（max）为10.3（范围0-87），中位TLG为85.7（范围0-3227）。肿瘤长度> 5cm、临床分期高、TNM分期肿瘤和淋巴结类型高的患者SUV（max）和TLG均较高（均P < 0.0001）。在234例可评价治愈的患者中，60例（25.6%）达到治愈。在多变量logistic回归模型中，低TLG（而非低SUVmax）与治愈相关（连续TLG值：比值比0.70，95%置信区间（CI）0.54-0.92）。TLG被量化为4个四分位数分类变量;第一个四分位数（Q1; 228.4）; Q4的治愈率仅为10.3%，Q3为5.1%，但Q2增加至28.8%，Q1为58.6%。交叉验证的平均预测准确度评分为0.81（95% CI，0.75-0.86）。结论：在这个交叉验证的模型中，第一四分位数中有59%的患者在明确的放化疗后治愈。基线TLG可作为食管保存的工具之一。
Objective: We aimed to determine whether tumor metabolism could be prognostic of cure in L-EAC patients who receive definitive chemoradiation. Summary Background Data: Patients with inoperable localized esophageal adenocarcinoma (L-EAC) often receive definitive chemoradiation; however, biomarkers and/or imaging variables to prognosticate cure are missing. Methods: Two hundred sixty-six patients with L-EAC who had chemoradiation but not surgery were analyzed from the prospectively maintained EAC databases in the Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center (Texas, USA) between March 2002 and April 2015. Maximumstandardized uptake value (SUVmax) and total lesion glycolysis (TLG) from the positron emission tomography data were evaluated. Results: Of 266 patients, 253 (95%) were men; the median age was 67 years (range 20-91 yrs) and 153 had poorly differentiated L-EAC. The median SUV(max)was 10.3 (range 0-87) and the median TLG was 85.7 (range 0-3227). Both SUV(max)and TLG were higher among those with: tumors >5 cm in length, high clinical stage, and high tumor and node categories by TNM staging (allP< 0.0001). Of 234 patients evaluable for cure, 60 (25.6%) achieved cure. In the multivariable logistic regression model, low TLG (but not low SUVmax) was associated with cure (continuous TLG value: odds ratio 0.70, 95% confidence interval (CI) 0.54-0.92). TLG was quantified into 4 quartile categorical variables; first quartile (Q1; 228.4); the cure rate was only 10.3% in Q4 and 5.1% in Q3 but increased to 28.8% in Q2, and 58.6% in Q1. The cross-validation resulted in an average accuracy of prediction score of 0.81 (95% CI, 0.75-0.86). Conclusions: In this cross-validated model, 59% of patients in the 1st quartile were cured following definitive chemoradiation. Baseline TLG could be pursued as one of the tools for esophageal preservation.