ORIGINAL ARTICLE   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2020 June;64(2):211-8

DOI: 10.23736/S1824-4785.18.03041-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Total FDG lesion number on PET/CT predicts survival of esophageal carcinoma patients with recurrence following curative surgery

Soo J. KIM ¹, Seung H. HYUN ¹, Seung H. MOON ¹, Young S. CHO ¹, Hyun K. YI ¹, Young M. SHIM ², Joon Y. CHOI ¹, Byung-Tae KIM ¹, Kyung-Han LEE ¹ ✉

¹ Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; ² Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

BACKGROUND: Total lesion number is a prognostic determinant in recurrent esophageal cancer, but this requires multiple tests. Here, we investigated the prognostic value of total FDG lesion number obtained from a single PET/CT study.
METHODS: Subjects were 153 esophageal squamous cell carcinoma patients with loco-regional or distant recurrence following curative surgery. FDG PET/CT performed within 30 days was inspected for abnormal FDG uptake lesions using a SUVmax of 3.0 as threshold for significance. Prognostic associations were assessed by Cox proportional hazards regression and Kaplan-Meier analysis.
RESULTS: PET/CT showed significant local FDG lesions in 49.0%, regional lesions in 78.4%, and distant lesions in 44.4% of patients. Among 73 patients with loco-regional recurrence, 54 had 0-3 and 19 had ≥4 FDG lesions. Among 80 patients with distant recurrence, 31 had 0-3 and 49 had ≥4 FDG lesions. During a median follow-up of 11.8 months, 99 deaths occurred. Univariate variables associated with poor survival included ≥4 FDG lesions and no treatment for loco-regional recurrence and no treatment for distant recurrence. Kaplan Meier analysis showed worse survival for ≥4 than 0-3 FDG lesions in patients with loco-regional recurrence (15.6 vs. 32.1 months; P=0.009), but not in those with distant recurrence. Significant independent predictors of poor survival were ≥4 FDG lesions and no treatment for loco-regional recurrence and no treatment for distant recurrence.
CONCLUSIONS: Total FDG lesion number assessed by PET/CT is a significant independent prognostic factor in esophageal cancer patients with loco-regional recurrence following curative surgery.

KEY WORDS: Fluorodeoxyglucose F18; Positron emission tomography/computed tomography; Neoplasm recurrence, local; Survival; Esophageal squamous cell carcinoma