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Clinical Significance of 18F-Fluorodeoxyglucose-Positron Emission Tomography-Positive Lymph Nodes to Outcomes of Trimodal Therapy for Esophageal Squamous Cell Carcinoma

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

Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Yoichi Hamai MD, PhD, Manabu Emi MD, PhD, Yuta Ibuki MD, Takaoki Furukawa MD, PhD & Morihito Okada MD, PhD

  2. Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Jun Hihara MD, PhD & Yoshiro Aoki MD, PhD

  3. Department of Radiation Oncology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Yuji Murakami MD, PhD, Ikuno Nishibuchi MD, PhD & Yasushi Nagata MD, PhD

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  1. Yoichi Hamai MD, PhD
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Correspondence to Yoichi Hamai MD, PhD.

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Fig. S1

Station numbers and anatomic locations of regional lymph nodes based on the guidelines of the Japanese Society for Esophageal Diseases.40A Border between neck and upper mediastinum. B Border between upper and middle mediastinum (bifurcation of trachea). C Border between middle and lower mediastinum. D Border between lower mediastinum and abdomen (diaphragm) (JPEG 229 kb)

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Hamai, Y., Hihara, J., Emi, M. et al. Clinical Significance of 18F-Fluorodeoxyglucose-Positron Emission Tomography-Positive Lymph Nodes to Outcomes of Trimodal Therapy for Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 26, 1869–1878 (2019). https://doi.org/10.1245/s10434-019-07158-5

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  • DOI: https://doi.org/10.1245/s10434-019-07158-5

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