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Prognostic Significance of 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET)-Positive Lymph Nodes Following Neoadjuvant Chemotherapy and Surgery for Resectable Thoracic Esophageal Squamous Cell Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Patients with resectable thoracic esophageal squamous cell cancer (TESCC) and positron emission tomography (PET)-positive lymph nodes (PET-N positive) are likely to have ≥3 pathological lymph node metastases (pLNMs) and show a higher rate of postoperative recurrence despite curative resection than PET-N-negative TESCC patients. We examined the prognostic significance of 18F-fluorodeoxyglucose uptake into lymph node metastases after neoadjuvant chemotherapy (NAC) for PET-N positive TESCC and aimed to propose the optimal NAC response criteria for these patients.

Methods

Fifty-one patients with PET-N positive TESCC underwent two courses of NAC followed by surgery. Metabolic responses of primary tumors and LNs were prospectively evaluated and associations with clinicopathological data and patient survival assessed by univariate and multivariate analyses.

Results

After NAC, 21 patients were post-treatment (post-) PET-N positive and 30 post-PET-N negative. A significantly (p < 0.001) high proportion of the post-PET-N-negative group had ≤2 pLNMs than the post-PET-N positive group (86.7 vs. 28.6 %). The PET-N negative group also had a significantly lower distant metastasis rate (23.3 vs. 75.0 %) and higher 5-year relapse-free survival (RFS) rate (69.0 vs. 20.0 %). Univariate and multivariate Cox’s proportional hazard regression analyses identified post-PET-N negative status as the only significant favorable predictive factor for low postoperative recurrence (p = 0.015) independent of the primary tumor response.

Conclusions

PET-N negative status predicts ≤2 pLNMs and longer RFS in resectable TESCC patients even after NAC. Therefore, post-PET-N status, not the effects on the primary tumor, is a critical NAC treatment response criterion for evaluating prognosis and guiding subsequent treatment.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka, Japan

    Takushi Yasuda M.D.

  2. Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Masahiko Yano M.D. & Yoshiyuki Fujiwara M.D.

  3. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Hiroshi Miyata M.D., Makoto Yamasaki M.D., Shuji Takiguchi M.D. & Yuichiro Doki M.D.

Authors
  1. Takushi Yasuda M.D.
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  2. Masahiko Yano M.D.
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  3. Hiroshi Miyata M.D.
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  4. Makoto Yamasaki M.D.
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  5. Shuji Takiguchi M.D.
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  6. Yoshiyuki Fujiwara M.D.
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  7. Yuichiro Doki M.D.
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Corresponding author

Correspondence to Takushi Yasuda M.D..

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10434_2014_4299_MOESM1_ESM.ppt

Supplemental Fig. E1 Relapse-free survival according to the number of pathologically metastatic lymph nodes. Each percent value shows 5-year survival rate (PPT 171 kb)

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Yasuda, T., Yano, M., Miyata, H. et al. Prognostic Significance of 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET)-Positive Lymph Nodes Following Neoadjuvant Chemotherapy and Surgery for Resectable Thoracic Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 22, 2599–2607 (2015). https://doi.org/10.1245/s10434-014-4299-9

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  • DOI: https://doi.org/10.1245/s10434-014-4299-9

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