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The role of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant PD-1 blockade in combination with chemotherapy for resectable esophageal squamous cell carcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Accurate assessment of residual disease of tumor and lymph nodes after neoadjuvant immunochemotherapy is crucial in the active surveillance for patients with pathological complete response (pCR) and the optimal extent of lymphadenectomy for patients with non-pCR. This post hoc analysis aimed to evaluate the performance of 18F-FDG PET/CT to predict the pathological response to neoadjuvant immunochemotherapy for esophageal squamous cell carcinoma (ESCC).

Methods

Fifty-eight resectable ESCC patients received two cycles of camrelizumab in combination with chemotherapy and were enrolled in the final analysis. The 18F-FDG PET/CT scans were acquired at baseline (scan-1) and after immunochemotherapy but prior to surgery (scan-2). Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), tumor-to-blood pool SUVmax ratio (SUVTBR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated for their association with the pathological response to immunochemotherapy.

Results

Nineteen patients (32.8%, 19/58) had pCR and thirty-nine patients (67.2%, 39/58) had non-pCR after two doses of camrelizumab and chemotherapy. At scan-2, the SUVmax, SUVmean, SUVTBR, TLG, and MTV were significantly lower in pCR than in non-pCR patients. Decrease in TLG and MTV between scan-2 and scan-1 of the same patient was significantly higher in the pCR than in the non-pCR group. In the receiver operating characteristic curve analysis, SUVmax, SUVmean, SUVTBR, TLG, and MTV in scan-2 showed excellent predictive value for the pCR of primary tumors. Furthermore, SUVmax in scan-2 were higher in positive lymph nodes than in negative ones, suggesting a high negative predictive ability (98.6%) with a cut-off value at 1.4.

Conclusion

The parameters of 18F-FDG PET/CT have the excellent performance for predicting pCR after the combined neoadjuvant immunochemotherapy in resectable ESCC.

Trial registration

ChiCTR2000028900. Registered on January 6, 2020.

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Abbreviations

pCR:

Pathological complete response

ESCC:

Esophageal squamous cell carcinoma

SUVmax :

Maximum standardized uptake value

SUVmean :

Mean standardized uptake value

SUVTBR :

Tumor-to-blood pool SUVmax ratio

MTV:

Metabolic tumor volume

TLG:

Total lesion glycolysis

nCRT:

Neoadjuvant chemoradiotherapy

PD-1:

Programmed cell death 1

DFS:

Disease-free survival

OS:

Overall survival

EC:

Esophageal cancer

18F-FDG:

Fluorine 18-fluorodeoxyglucose

SAD:

Short axis diameter

IQR:

Interquartile range

ROC:

Receiver operating characteristic

AUC:

Area under the ROC curve

PPV:

Positive predictive value

NPV:

Negative predictive value

CI:

Confidence intervals

LN:

Lymph node

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Acknowledgements

We thank the patients and their family members who gave their consent to participate in this study, as well as the research staffs at our hospital who carried out the study.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China

    Xiaoyan Wang, Hui Luo & Xiangsong Zhang

  2. Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China

    Weixiong Yang, Shuishen Zhang, Yi Gan, Bo Zeng, Zhenguo Liu & Chao Cheng

  3. Department of Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Qian Zhou

  4. Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Wenfang Chen

  5. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sai-Ching Jim Yeung

  6. Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Shiting Feng

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  1. Xiaoyan Wang
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Corresponding authors

Correspondence to Xiangsong Zhang or Chao Cheng.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards as previously reported (PMID: 35022193).

Consent to participate

Informed consent was obtained from all patients enrolled in the study.

Conflict of interest

The authors declare no conflict of interest relevant to this study. Outside the context of this study, Dr. Yeung had prior grant funding from Bristol-Myer Squibb, Assertio (previously DepoMed), and Bausch Health, and participated in an expert panel for Celgene, Inc.

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Xiaoyan Wang, Weixiong Yang, and Qian Zhou contributed equally as first authors.

This article is part of the Topical Collection on Oncology—Digestive tract.

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Wang, X., Yang, W., Zhou, Q. et al. The role of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant PD-1 blockade in combination with chemotherapy for resectable esophageal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 49, 4241–4251 (2022). https://doi.org/10.1007/s00259-022-05872-z

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