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Relationship Between Clinicopathological Characteristics and PET/CT Uptake in Esophageal Squamous Cell Carcinoma: [18F]Alfatide versus [18F]FDG

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Abstract

Purpose

To assess a novel radiotracer aluminum [18F]fluoride-1,4,7-triazacyclononane-triacetic acid-pegylated dimeric RGD ([18F]ALF-NOTA-PRGD2, denoted as [18F]Alfatide) for positron emission tomography (PET)/X-ray computed tomography (CT) and explore the relationships between clinicopathological characteristics and maximum standard uptake values in primary (SUVP) and metastatic lymph nodes (SUVLN) of patients with esophageal squamous cell carcinoma (ESCC), as verified by pathologic examination and compared with those obtained with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]DG) PET.

Procedures

We prospectively enrolled patients with newly diagnosed ESCC who agreed to undergo [18F]Alfatide PET/CT or [18F]FDG PET/CT scans before surgery at Shandong Cancer Hospital from May 2011 to July 2017. SUVs and the pathological tumor-node-metastasis (pTNM) stages of primary tumors and metastatic lymph nodes (LNs) were measured and confirmed pathologically. Immunohistochemical (IHC) staining for integrin αvβ3 was performed on tumor samples (both primary tumors and metastatic LNs) collected from nine patients.

Results

Of 61 patients who underwent PET/CT scans, 46 then underwent curative surgery and were included in our analysis (n = 21 for [18F]Alfatide PET/CT and n = 25 for [18F]FDG PET/CT). No significant differences in the SUVP on [18F]Alfatide PET/CT or [18F]FDG PET/CT were observed among the cohorts according to gender, pathological stage, T stage, status of LNs, and differentiation (all P > 0.05). The SUVLN differed significantly between the pathological stages and status of LNs both on [18F]Alfatide PET/CT (P = 0.03, 0.003) and [18F]FDG PET/CT (P = 0.001. < 0.001), but not according to gender (P = 0.128, 0.129), T stage (P = 0.791, 0.727), or tumor differentiation (P = 0.049, 0.053). Significant positive correlations were observed between the SUVLN on [18F]Alfatide PET/CT and [18F]FDG PET/CT, and pathological stage (r = 0.52, P = 0.016; r = 0.503, P = 0.01), LN status (r = 0.73, P < 0.001; r = 0.649, P < 0.001), and differentiation (r = 0.509, P < 0.019; r = 0.459, P = 0.021) were observed. No significant differences were found between the relationships of SUVP with SUVLN, length, age, gender, pathological stage, T stage, status of LN, or differentiation, or of SUVLN with length, age, gender, or T stage both on [18F]Alfatide PET/CT and [18F]FDG PET/CT (all P > 0.05). The quantitated expression levels of αvβ3 in primary tumors and metastatic LNs were 1.67 ± 1.12 and 3.42 ± 2.93, respectively (P = 0.031).

Conclusions

Our results suggest that SUVLN is influenced by pathological stage, LN status, and differentiation. SUVLN may therefore serve as a new parameter for risk stratification of with ESCC patients. Moreover, [18F]Alfatide PET can provide complementary molecular information about ESCC metastasis.

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Acknowledgments

The authors extend their gratitude to Professor Yongsheng Gao (Department of Pathology, Shandong Cancer Hospital and Institute) for his help with IHC analysis and Jianbo Zhang (Department of Pathology, Shandong Cancer Hospital and Institute) for his help with the IHC examination.

Funding

This study was partially funded by the Special Fund for Scientific Research in the Public Interest (201402011), the National Key Research and Development Plan (2016YFC0904700), the Natural Science Foundation of China (NSFC81172133, NSFC81372413), the Shandong Key Research and Development Plan (2017CXGC1209 and 2017GSF18164), and the Outstanding Youth Natural Science Foundation of Shandong Province (JQ201423).

Author information

Author notes

  1. Yinjun Dong and Yuchun Wei contributed equally to this work.

Authors and Affiliations

  1. Shandong University, Jinan, China

    Yinjun Dong

  2. Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China

    Yinjun Dong, Pingping Song & Shuguang Liu

  3. Shandong Academy of Medical Sciences, Jinan, China

    Yinjun Dong, Yuchun Wei, Guanxuan Chen, Yong Huang, Pingping Song, Shuguang Liu, Jinsong Zheng & Shuanghu Yuan

  4. Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China

    Yuchun Wei & Shuanghu Yuan

  5. Department of Intensive Care Unit, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China

    Guanxuan Chen

  6. Department of Nuclear Medicine, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China

    Yong Huang & Jinsong Zheng

  7. Indiana University School of Medicine (IUSM), Indianapolis, USA

    Monica Cheng

  8. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, China

    Shuanghu Yuan

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  1. Yinjun Dong
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Corresponding author

Correspondence to Shuanghu Yuan.

Ethics declarations

This study was approved by the ethics committee of Shandong Cancer Hospital, and each patient provided written informed consent prior to the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Dong, Y., Wei, Y., Chen, G. et al. Relationship Between Clinicopathological Characteristics and PET/CT Uptake in Esophageal Squamous Cell Carcinoma: [18F]Alfatide versus [18F]FDG. Mol Imaging Biol 21, 175–182 (2019). https://doi.org/10.1007/s11307-018-1216-9

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  • DOI: https://doi.org/10.1007/s11307-018-1216-9

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