Clinical Significance of 18F-Fluorodeoxyglucose-Positron Emission Tomography-Positive Lymph Nodes to Outcomes of Trimodal Therapy for Esophageal Squamous Cell Carcinoma
- 47 Downloads
The clinical significance of lymph node (LN) status determined by preoperative 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) has not been investigated in patients with locally advanced esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (NCRT) followed by surgery (trimodal therapy).
This study reviewed 132 consecutive patients with ESCC who had been preoperatively evaluated using FDG-PET before and after NCRT to analyze associations among LN status according to PET findings, pathologic LN metastasis, and prognosis of ESCC after trimodal therapy.
Lymph nodes that were PET-positive both before and after NCRT comprised significant predictive markers of pathologic LN metastasis in station-by-station analyses (sensitivity, specificity, and accuracy respectively 41.7%, 95.0%, and 92.7% before, and 12.0%, 99.4%, and 95.6% after NCRT; both p < 0.0001). The numbers of LNs evaluated using PET before and after NCRT were significantly associated with those of pathologic metastatic LNs. Uni- and multivariable analyses selected LN status determined by PET before NCRT as a significant independent predictor of both recurrence-free [LN-negative vs LN-positive: hazard ratio (HR) 1.90; 95% confidence interval (CI) 1.02–3.23; p = 0.045] and overall survival (HR 2.62; 95% CI 1.29–5.30; p = 0.01).
The status of LN determined by preoperative FDG-PET is significantly associated with pathologic LN status and the prognosis of ESCC with trimodal therapy. Thus, FDG-PET is a useful diagnostic tool for preoperative prediction of pathologic LN metastasis and survival among patients with ESCC.
There are no conflicts of interest.
- 11.Hamai Y, Hihara J, Emi M, Furukawa T, Yamakita I, Kurokawa T, Okada M. Ability of fluorine-18fluorodeoxyglucose positron emission tomography to predict outcomes of neoadjuvant chemoradiotherapy followed by surgical treatment for esophageal squamous cell carcinoma. Ann Thorac Surg. 2016;102:1132–9.CrossRefGoogle Scholar
- 12.Cong L, Wang S, Gao T, Hu L. The predictive value of 18F-FDG PET for pathological response of primary tumor in patients with esophageal cancer during or after neoadjuvant chemoradiotherapy: a meta-analysis. Jpn J Clin Oncol. 2016;46:1118–26.Google Scholar
- 13.Sobin L, Gospodarowicz M, Wittekind C, editors. International Union Against Cancer (UICC): TNM Classification of Malignant Tumours. 7th ed. New York: Wiley; 2009.Google Scholar
- 18.Yasuda T, Yano M, Miyata H, Yamasaki M, Takiguchi S, Fujiwara Y, Doki Y. 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. 2015;22:2599–607.CrossRefGoogle Scholar
- 25.Ela Bella AJ, Zhang YR, Fan W, et al. Maximum standardized uptake value on PET/CT in preoperative assessment of lymph node metastasis from thoracic esophageal squamous cell carcinoma. Chin J Cancer. 2014;33:211–7.Google Scholar
- 32.Kato H, Kimura H, Nakajima M, et al. The additional value of integrated PET/CT over PET in initial lymph node staging of esophageal cancer. Oncol Rep. 2008;20:857–62.Google Scholar
- 34.Okada M, Murakami T, Kumano S, Kuwabara M, Shimono T, Hosono M, Shiozaki H. Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early-stage esophageal cancer. Ann Nucl Med. 2009;23:73–80.CrossRefGoogle Scholar
- 39.Deng HY, Wang WP, Wang YC, Hu WP, Ni PZ, Lin YD, Chen LQ. Neoadjuvant chemoradiotherapy or chemotherapy? A comprehensive systematic review and meta-analysis of the options for neoadjuvant therapy for treating oesophageal cancer. Eur J Cardiothorac Surg. 2017;51:421–31.Google Scholar