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Predictive value of repeated F-18 FDG PET/CT parameters changes during preoperative chemoradiotherapy to predict pathologic response and overall survival in locally advanced esophageal adenocarcinoma patients

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Abstract

Introduction

The goal of the current study was to investigate the predictive and prognostic values of repeated F-18 FDG PET/CT parameter changes for prediction of complete pathologic response (pCR) in patients with adenocarcinoma of locally advanced esophageal cancer (LAEC) who received preoperative concurrent chemoradiotherapy (PCRT).

Methods

A total 53 patients with LAEC patients were included in the current study. All patients were evaluated by F-18 FDG PET/CT before and during chemoradiotherapy. The percent changes (∆, %) in F-18 FDG PET/CT parameters were used to predict pCR and to calculate overall survival (OS). The predictive value for pCR of F-18 FDG PET/CT cutoff values was determined by ROC analysis. The prognostic significance was assessed using Kaplan–Meier analysis.

Results

pCR occurred in 15 patients (28.3 %). When ΔSUVmax > 23.5 % was used as cutoff, the sensitivity and specificity of F-18 FDG PET/CT for prediction of pCR were 100 % and 52.6, respectively. The AUC was 0.750 (95 % CI; 0.612–0.859), and standard error (SE) was 0.0633 (p = 0.0002). ΔMTV resulted in 80 % sensitivity, 76.3 % specificity, and 0.731 AUC (95 % CI; 0.591–0.843, SE = 0.077, p = 0.0027) for cutoff values >25.5 %. When ΔTLG > 44.8 % was used as cutoff, the sensitivity and specificity of F-18 FDG PET/CT for prediction of pCR were 100 and 65.8 %, respectively. The AUC was 0.893 (95 % CI; 0.777–0.961), and SE was 0.0431 (p < 0.0001). Kaplan–Meier analysis showed that high ΔSUVmax, ΔMTV, and ΔTLG were associated with improved OS.

Conclusion

In conclusion, the current study shows the capability of the changes (Δ) in repeated F-18 FDG PET/CT parameters to predict the achievement of pCR during PCRT in LAEC patients. Among the parameters, the ΔSUVmax, ΔMTV, and ΔTLG were predictors for pCR and well associated with OS.

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Acknowledgments

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea (0920050).

Funding

This study was not funded by any grant.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Pusan National University Hospital, Busan, 602-739, Republic of Korea

    Seong-Jang Kim

  2. Biomedical Research Institute, Pusan National University Hospital, Busan, 602-739, Republic of Korea

    Seong-Jang Kim

  3. Department of Radiology, University of Colorado School of Medicine, 12401 E 17th Ave, L-954, Aurora, CO, 80045, USA

    Phillip J. Koo & Samuel Chang

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  1. Seong-Jang Kim
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Correspondence to Seong-Jang Kim.

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The authors reported that they have no conflicts of interest regarding to the current study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was waived because of retrospective characteristics of the current study.

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Kim, SJ., Koo, P.J. & Chang, S. Predictive value of repeated F-18 FDG PET/CT parameters changes during preoperative chemoradiotherapy to predict pathologic response and overall survival in locally advanced esophageal adenocarcinoma patients. Cancer Chemother Pharmacol 77, 723–731 (2016). https://doi.org/10.1007/s00280-016-2988-8

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  • DOI: https://doi.org/10.1007/s00280-016-2988-8

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