Confirmation of the prognostic value of pretherapeutic tumor SUR and MTV in patients with esophageal squamous cell carcinoma
Confirmation of the prognostic value of pretherapeutic tumor SUR and MTV in patients with esophageal squamous cell carcinoma
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DOI：
10.1007/s00259-019-04307-6
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发表时间：
2019-07-01
影响因子：
9.1
通讯作者：
Zschaeck, Sebastian
中科院分区：
文献类型：
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作者：
Hofheinz, Frank;Li, Yimin;Zschaeck, Sebastian
目的不能手术食管癌患者的预后仍然较差，基于临床参数的个体化治疗预后预测的可靠性不高。在最近发表的一篇文章中，我们能够证明PET可以在这样的患者组中提供独立的预后信息，并且肿瘤-血液标准摄取比（SUR）可以提高示踪剂摄取值的预后价值。目前的研究解决了一个问题，即在不同部位接受检查和治疗的类似患者组中，是否可以证实SUR明显改善的预后价值。方法对147例确诊食管鳞状细胞癌患者（男115例，女32例，平均年龄62岁）进行F-FDG PET/CT检查。在PET图像中，采用自适应阈值法描绘原发肿瘤的代谢活性体积（MTV）。对于所得的roi，计算SUVmax和总病变糖酵解（TLG = MTV x SUVmean）。在低剂量CT上通过人工圈定主动脉来测定血SUV。以肿瘤SUV与血液SUV之比计算SUR值。对总生存期（OS）、无远处转移生存期（DM）和局部区域对照（LRC）进行单因素Cox回归和Kaplan-Meier分析。此外，还进行了包括临床相关参数的多变量Cox回归。结果单因素Cox回归分析显示MTV、TLG和SURmax是OS的重要预后因素。MTV和TLG是LRC的显著预后因素，而SURmax仅呈显著趋势。PET参数均不能作为DM的预后指标。在单变量分析中，SUVmax对任何研究的临床终点都不能作为预后指标。在多变量分析（t期、n期、MTV和SURmax）中，MTV是OS的独立预后因素，对LRC有显著性趋势。SURmax不是OS或LRC的独立预测因子。当在多变量分析中单独纳入PET参数时，MTV和SURmax是OS的预后因素，这表明SURmax与临床参数无关，而与MTV无关。此外，MTV是LRC的独立预测因素。结论与肿瘤SUV相比，sour研究显示了肿瘤SUR明显改善的预后价值，证实了我们之前发表的关于OS的研究结果。此外，在该患者组中，SUR提供了超出临床参数单独提供的预后信息，但没有增加MTV提供的预后信息。因此，我们的研究结果表明，治疗前MTV是基于pet的风险分层的选择参数，但需要进一步的调查来证明这一建议是正确的。
PurposeThe prognosis for patients with inoperable esophageal carcinoma is still poor and the reliability of individual therapy outcome prediction based on clinical parameters is not convincing. In a recent publication, we were able to show that PET can provide independent prognostic information in such a patient group and that the tumor-to-blood standard uptake ratio (SUR) can improve the prognostic value of tracer uptake values. The present investigation addresses the question of whether the distinctly improved prognostic value of SUR can be confirmed in a similar patient group that was examined and treated at a different site.Methods(18)F-FDG PET/CT was performed in 147 consecutive patients (115 male, 32 female, mean age: 62 years) with newly diagnosed esophageal squamous cell carcinoma prior to definitive radiochemotherapy. In the PET images, the metabolic active volume (MTV) of the primary tumor was delineated with an adaptive threshold method. For the resulting ROIs, SUVmax and total lesion glycolysis (TLG = MTV x SUVmean) were computed. The blood SUV was determined by manually delineating the aorta in the low-dose CT. SUR values were computed as ratio of tumor SUV and blood SUV. Univariate Cox regression and Kaplan-Meier analysis with respect to overall survival (OS), distant-metastases-free survival (DM), and locoregional control (LRC) was performed. Additionally, a multivariate Cox regression including clinically relevant parameters was performed.ResultsUnivariate Cox regression revealed MTV, TLG, and SURmax as significant prognostic factors for OS. MTV as well as TLG were significant prognostic factors for LRC while SURmax showed only a trend for significance. None of the PET parameters was prognostic for DM. In univariate analysis, SUVmax was not prognostic for any of the investigated clinical endpoints. In multivariate analysis (T-stage, N-stage, MTV, and SURmax), MTV was an independent prognostic factor for OS and showed a trend for significance for LRC. SURmax was not an independent predictor for OS or LRC. When including the PET parameters separately in multivariate analysis, MTV as well as SURmax were prognostic factors for OS indicating that SURmax is independent from the clinical parameters but not from MTV. In addition, MTV was an independent prognostic factor for LRC in this separate analysis.ConclusionsOur study revealed a clearly improved prognostic value of tumor SUR compared to tumor SUV and confirms our previously published findings regarding OS. Furthermore, SUR delivers prognostic information beyond that provided by the clinical parameters alone, but does not add prognostic information beyond that provided by MTV in this patient group. Therefore, our results suggest that pretherapeutic MTV is the parameter of choice for PET-based risk stratification in the considered setting but further investigations are necessary to demonstrate that this suggestion is correct.