Prognostic Value of Initial FDGPET or CT Metabolic Tumor Volume in Patients with Resectable Esophageal Adenocarcinoma - Abstract
Objective: Clinical guidelines suggest that pretreatment clinical staging of
esophageal adenocarcinoma with 18F-fluorodeoxyglucose (FDG) positron emission
tomography (PET/CT) should be used to guide therapy. It is now felt that in the absence
of metastatic disease, maximum standard uptake value (SUVmax) on the initial FDG
study is poorly predictive of prognosis in patients with locally advanced disease.
Perhaps this is because SUVmax accounts for intensity of uptake but not overall tumor
burden. We hypothesized that a novel index of image-derived parameters such as
metabolic tumor volume (MTV) could be more useful for determining prognosis in
patients with esophageal carcinoma.
Methods: A total of 185 consecutive patients who had a pre-treatment FDG
PET/CT for esophageal adenocarcinoma treated between 2002 and 2009 with
surgery alone (n=62) or neoadjuvant chemoradiotherapy (n=123) were included in
this study. Eight different volumetric metabolic models were assessed and compared
by Cox regression analyses against other clinicopathological variables of prognostic
significance.
Results: By univariate analysis tumor location, preoperative treatment, SUVmax,
endoscopic tumor length, clinical stage, and postsurgical stage were significant
predictors of survival. On multivariate analysis, clinical stage was the only independent
predictive factor associated with overall survival. Most significantly, our analyses,
including the use ofrecursive partitioning revealed that there were no useful FDG PET/
CT derived indices for determining prognosis.
Conclusion: Pretreatment SUVmax, and functional tumor uptake measurements
were not significant independent prognostic factors for overall survival.