Metabolic Tumor Volume Change Predicts Long-term Survival and Histological Response to Preoperative Chemotherapy in Locally Advanced Esophageal Cancer
Metabolic Tumor Volume Change Predicts Long-term Survival and Histological Response to Preoperative Chemotherapy in Locally Advanced Esophageal Cancer
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DOI：
10.1097/sla.0000000000002808
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发表时间：
2019-12-01
影响因子：
9
通讯作者：
Doki, Yuichiro
中科院分区：
文献类型：
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作者：
Makino, Tomoki;Yamasaki, Makoto;Doki, Yuichiro
目的：在这里，我们评估的能力，代谢肿瘤体积（MTV）测量的F-18-氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描（F-18-FDG PET/CT），以评估新辅助化疗反应的局部晚期食管癌（EC）患者（EC）背景：最佳的方法来评估治疗反应的EC患者尚未建立。尽管之前的研究已经报道了标准化摄取值（SUV）的价值，但预测EC组织学反应或长期生存的准确性有限。方法：总共分析了102例无远处转移的EC患者，在术前和术后接受了F-18-FDG PET/CT化疗系列。结果：术前化疗前后中位原发肿瘤MTV值分别为22.55（范围0.4-183.1）和2.75（0-52.9），中位MVT减少率为86.5%。采用10%逐步截断分析，我们发现PET应答者和无应答者之间的生存率差异最显著，截断值为MTV降低60%[2年无进展生存率（PFS）：79.2% vs 44.4%;风险比（HR）3.397; P < 0.0001]。在此临界值下，组织学反应（P = 0.0091）、肿瘤位置（P = 0.0102）、pT（P = 0.0011）和pN（P = 0.0110）与PET反应显著相关。PFS的单变量分析表明PFS与肿瘤大小、cT、CT显示的原发病灶缩小、SUVmax降低率、MTV降低率、pT、pN和pM相关。多变量分析进一步确定了pM（HR 3.063; P = 0.0279）和MTV降低率（HR 2.471; P = 0.0263）是独立的预后预测因子，但与CT原发灶缩小或SUVmax降低率无关。MTV变化在临床上可用于预测EC患者的长期生存和术前化疗的组织学反应，在基于生存分析确定最佳截止值之后。
Objective: Here, we assess the ability of metabolic tumor volume (MTV) as measured by F-18-fluorodeoxyglucose-positron emission tomography/computed tomography (F-18-FDG PET/CT) to evaluate neoadjuvant chemotherapy response for patients with locally advanced esophageal cancer (EC).Background: Optimal methods to evaluate treatment response for EC patients have not yet been established. Although previous studies have reported the value of standardized uptake value (SUV), the accuracy of predicting histological response or long-term survival in EC is limited.Methods: In all, 102 EC patients without distant metastasis who underwent F-18-FDG PET/CT both before and after the preoperative chemotherapy series were analyzed.Results: The median primary tumor MTV values before and after preoperative chemotherapy were 22.55 (range 0.4-183.1) and 2.75 (0-52.9), respectively, and the median MVT reduction rate was 86.5%. We found the most significant difference in survival between PET responders and nonresponders with a cut-off value of 60% MTV reduction, using a 10% stepwise cut-off analysis [2-year progression-free survival (PFS): 79.2 vs 44.4%; hazard ratio (HR) 3.397; P < 0.0001). With this cut-off value, histological response (P = 0.0091), tumor location (P = 0.0102), pT (P = 0.0011), and pN (P = 0.0110) were significantly associated with PET response. Univariate analysis of PFS indicated a correlation between PFS and tumor size, cT, decrease of primary lesion by CT, SUVmax reduction rate, MTV reduction rate, pT, pN, and pM. Multivariate analysis further identified pM (HR 3.063; P = 0.0279) and MTV reduction rate (HR 2.471; P = 0.0263) to be independent prognostic predictors, but not decrease of primary lesion by CT or SUVmax reduction rate.Conclusion: MTV change is clinically useful in predicting both long-term survival and histological response to preoperative chemotherapy in EC patients, after determining the optimal cut-off value based on survival analysis.