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Tumor/normal esophagus ratio in 18F-fluorodeoxyglucose positron emission tomography/computed tomography for response and prognosis stratification after neoadjuvant chemotherapy for esophageal squamous cell carcinoma

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Abstract

Background

Positron emission tomography (PET) response criteria in solid tumors were recently proposed as a standardized method for the metabolic and quantitative assessment of response to chemotherapy. However, use of these criteria is limited in many institutions because of the need for exclusive software. This study was designed to clarify whether tumor to normal esophageal (T/N) ratio on 18F-fluorodeoxyglucose PET/computed tomography could predict response to neoadjuvant chemotherapy and stratify prognosis in patients with esophageal squamous cell carcinoma (ESCC).

Methods

Clinicopathological data were collected for 73 patients with ESCC who received neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by curative resection. The right liver lobe and normal esophagus were utilized as reference tissues for diagnosing complete metabolic response (CMR). Statistical methods included Kaplan–Meier analysis and univariate and multivariate Cox proportional hazards regression analyses.

Results

CMR was achieved in 24 patients on the basis of maximum standardized uptake value (SUVmax) and in 11 on the basis of SUVmax evaluation with T/N ratio. Although prognosis was poorer in patients who achieved CMR than partial metabolic response based on SUVmax, the responses were significantly correlated with disease-free survival (DFS) based on SUVmax evaluation with T/N ratio (P = 0.0011). Receiver operating characteristic curve analysis showed that SUVmax evaluation with T/N ratio was the best predictor of pGrade 3. Multivariate analysis showed that SUVmax evaluation with T/N ratio was an independent predictor of DFS in patients with pGrade 1 pathologic response.

Conclusions

SUVmax evaluation with T/N ratio is useful for evaluating the effects of neoadjuvant chemotherapy in patients with ESCC.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Dasiuke Izumi, Naoya Yoshida, Takatsugu Ishimoto, Keisuke Kosumi, Ryuma Tokunaga, Katsunobu Taki, Takaaki Higashi, Kazuto Harada, Tatsunori Miyata, Shiro Iwagami, Yoshifumi Baba, Yasuo Sakamoto, Yuji Miyamoto & Hideo Baba

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Masayuki Watanabe, Satoshi Ida & Yu Imamura

  3. Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Shinya Shiraishi & Yasuyuki Yamashita

Authors
  1. Dasiuke Izumi
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  2. Naoya Yoshida
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  3. Masayuki Watanabe
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  4. Shinya Shiraishi
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  5. Takatsugu Ishimoto
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  6. Keisuke Kosumi
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  7. Ryuma Tokunaga
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  8. Katsunobu Taki
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  9. Takaaki Higashi
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  10. Kazuto Harada
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  11. Tatsunori Miyata
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  12. Satoshi Ida
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  13. Yu Imamura
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  14. Shiro Iwagami
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  15. Yoshifumi Baba
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  16. Yasuo Sakamoto
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  17. Yuji Miyamoto
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  18. Yasuyuki Yamashita
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  19. Hideo Baba
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Corresponding author

Correspondence to Hideo Baba.

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The authors declare that they have no conflicts of interest.

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Izumi, D., Yoshida, N., Watanabe, M. et al. Tumor/normal esophagus ratio in 18F-fluorodeoxyglucose positron emission tomography/computed tomography for response and prognosis stratification after neoadjuvant chemotherapy for esophageal squamous cell carcinoma. J Gastroenterol 51, 788–795 (2016). https://doi.org/10.1007/s00535-015-1150-4

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  • DOI: https://doi.org/10.1007/s00535-015-1150-4

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