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Maximum standardized uptake value change rate before and after neoadjuvant chemotherapy can predict early recurrence in patients with locally advanced esophageal cancer: a multi-institutional cohort study of 220 patients in Japan

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Abstract

Background

Neoadjuvant chemotherapy (NAC) followed by esophagectomy can improve the prognosis of locally advanced esophageal cancer (LAEC). However, LAEC reportedly recurred in 17–21% of patients within 6 months post surgery. Thus, current treatment strategies may be inadequate for LAECs with poor prognosis. Preoperative identification of patients with poor prognosis might aid in modification of treatment strategies. This study aimed to evaluate the usefulness of the maximum standardized uptake value change rate (ΔSUVmax) in predicting treatment effects on the primary lesion, prognosis, and LAEC recurrence.

Methods

This study involved 220 esophageal cancer patients who underwent esophagectomy after NAC at three facilities in Japan. The optimal cut-off point for ΔSUVmax in predicting tumor regression grade (TRG) was calculated and used to assess the correlation between ΔSUVmax and postoperative survival.

Results

The optimal cut-off point for ΔSUVmax was 0.5. The 5-year overall survival rate in patients with ΔSUVmax ≥ 0.5 was significantly higher than that in patients with ΔSUVmax < 0.5 (71.5% vs. 50.5%, P = 0.001). Multivariate analysis identified ΔSUVmax (hazards ratio, 0.496; P = 0.004) as an independent prognostic factor. Among 199 patients evaluated for recurrence, 24 (12.1%) showed recurrence within 6 months post surgery. Univariate analysis revealed ΔSUVmax as the only predictor for early recurrence (odds ratio, 0.222; P = 0.004).

Conclusion

ΔSUVmax before and after NAC is clinically useful as it could help predict TRG, survival outcome, and early recurrence within 6 months post esophagectomy and is easily obtainable in general clinical practice. We believe that it may also help determine suitable treatment strategies for LAEC.

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Acknowledgements

This study was conducted to update the Japanese Classification of Esophageal Cancer by the Japan Esophageal Society. The authors sincerely thank Yuichiro Doki, MD, and Koji Tanaka, MD, for their valuable assistance and direction in conducting this study.

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Authors and Affiliations

  1. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan

    Kentaro Murakami, Takeshi Toyozumi & Hisahiro Matsubara

  2. Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

    Takashi Uno

  3. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Naoya Yoshida & Hideo Baba

  4. Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan

    Yusuke Taniyama, Kozue Takahashi & Takashi Kamei

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  1. Kentaro Murakami
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  2. Naoya Yoshida
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  4. Kozue Takahashi
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  9. Hisahiro Matsubara
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Corresponding author

Correspondence to Kentaro Murakami.

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Ethical statement

This study was conducted in accordance with the principles of the Declaration of Helsinki. The Institutional Review Board at each institute approved the present study protocol (registry number: 19374 [Chiba University], 2011 [Kumamoto University], 2020-1-114 [Tohoku University]). The requirement for obtaining written informed consent from patients was waived because of the retrospective design of the study.

Conflict of interest

Dr. Naoya Yoshida is affiliated with a department supported by Chugai Pharmaceutical Co., Ltd., but declares no conflicts of interest in relation to this research. The rest of the authors have no financial conflicts of interest related to this study.

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Murakami, K., Yoshida, N., Taniyama, Y. et al. Maximum standardized uptake value change rate before and after neoadjuvant chemotherapy can predict early recurrence in patients with locally advanced esophageal cancer: a multi-institutional cohort study of 220 patients in Japan. Esophagus 19, 205–213 (2022). https://doi.org/10.1007/s10388-021-00896-0

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