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Efficacy of cell proliferation imaging with 4DST PET/CT for predicting the prognosis of patients with esophageal cancer: a comparison study with FDG PET/CT

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

Abstract

Purpose

4′-[Methyl-11C] thiothymidine (4DST) incorporates into DNA directly and is a PET tracer used for cell proliferation imaging. The aim of this study was to evaluate the prediction of prognosis with pretreatment 4DST PET/CT compared to fluorodeoxyglucose (FDG) PET/CT in patients with esophageal cancer.

Methods

In this prospective study, we analyzed 46 patients (68.2 ± 10.0 years old) with pathologically proven esophageal squamous cell cancer who underwent pretreatment 4DST and FDG PET/CT. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and total lesion proliferation (TLP) were measured for FDG and 4DST PET. The study endpoints were progression-free survival (PFS) and overall survival (OS). Patients’ clinical backgrounds, including age, histological type, clinical stage, and surgical treatment, were adjusted using the Cox proportional-hazards model.

Results

In the follow-up period (median 18.8 (interquartile range: 10.1–29.0) months), 26 and 19 patients showed disease progression and cancer-related death, respectively. After adjusting for clinical variables, only the 4DST parameters (SUVmax (p = 0.001) and TLP (p = 0.022)) were statistically significant for predicting PFS. FDG MTV (p = 0.031), 4DST SUVmax (p = 0.022), and TLP (p = 0.023) were statistically significant for predicting OS. Of the PET parameters, 4DST SUVmax yielded the highest adjusted hazard ratio for both PFS (4.88, 95% confidence intervals (CI): 1.83–12.97) and OS (4.19, 95% CI: 1.23–14.20).

Conclusion

Higher accumulation of 4DST in the primary tumor may lead to shorter OS and PFS. 4DST PET/CT is useful for predicting prognosis and may outperform FDG PET/CT.

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Data availability

The data that support the findings of this study are available from the corresponding author, [M.H], upon reasonable request.

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Funding

This work was supported by a Grant from (1) a Bayer Best Research Award 2017 (No. KJ-06) from the Japan Radiological Society (to Masatoshi Hotta), (2) a Grant-in Aid for Young Scientists (B) (No. 17K18396) from the Japan Society for the Promotion of Science (to Masatoshi Hotta), (3) Grant-in Aid for Young Scientists (No. 20K16746) from the Japan Society for the Promotion of Science (to Masatoshi Hotta), and (4) a Grant (No. 19A2009) from National Center for Global Health and Medicine (to Masatoshi Hotta). No other potential conflict of interest relevant to this article was reported.

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Authors and Affiliations

  1. Department of Nuclear Medicine, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Masatoshi Hotta, Ryogo Minamimoto & Kazuhiko Nakajima

  2. Department of Diagnostic Radiology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Masatoshi Hotta & Kei Takase

  3. Functional Brain Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan

    Jun Toyohara

  4. Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Kyoko Nohara & Kazuhiko Yamada

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  1. Masatoshi Hotta
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Correspondence to Masatoshi Hotta.

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This study was approved by the local Ethics Committee and was carried out in accordance with the 1964 Declaration of Helsinki.

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Hotta, M., Minamimoto, R., Toyohara, J. et al. Efficacy of cell proliferation imaging with 4DST PET/CT for predicting the prognosis of patients with esophageal cancer: a comparison study with FDG PET/CT. Eur J Nucl Med Mol Imaging 48, 2615–2623 (2021). https://doi.org/10.1007/s00259-020-05179-x

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