Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan,
Ann Surg Oncol. 2014 Feb;21(2):575-82. doi: 10.1245/s10434-013-3343-5. Epub 2013 Nov 8.
(18)F-FDG-PET is potentially useful for evaluating response to neoadjuvant therapy for esophageal cancer. However, the optimal (18)F-FDG-PET parameter for evaluating the response to therapy and survival has not been established. This study aimed to select the best of the two parameters of fluorodeoxyglucose ((18)F-FDG)-positron emission tomography (PET): decreased ratio of maximal standardized uptake (SUVmax-DR) or absolute value of posttreatment SUVmax (post-SUVmax), in predicting response and survival of patients with esophageal cancer who underwent neoadjuvant chemotherapy.
The study subjects were 211 consecutive patients with esophageal cancer who received neoadjuvant chemotherapy followed by surgery. (18)F-FDG-PET was performed before and 2-3 weeks after completion of neoadjuvant chemotherapy in assessment with pretreatment SUVmax (pre-SUVmax), post-SUVmax and SUVmax-DR.
The mean SUVmax decreased during neoadjuvant chemotherapy from 11.4 to 5.8, and the mean SUVmax-DR was 49.4%. Both post-SUVmax and SUVmax-DR correlated significantly with pathological response, although neither post-SUVmax nor SUVmax-DR could distinguish pathological complete response from pathological good response. The 5-year survival rate was significantly higher in patients with SUVmax-DR of >50% than those with <50% (56.5 vs. 39.6 %, p = 0.0137), and also significantly higher in patients with post-SUVmax of <3.5 than those with >3.5 (62.2 vs. 35.1%, p < 0.0001). Multivariate analysis identified post-SUVmax value, but not SUVmax-DR, as an independent prognostic factor in patients who underwent neoadjuvant chemotherapy.
Post-SUVmax is more useful for predicting survival of patients with esophageal cancer who undergo neoadjuvant therapy followed by surgery, although both SUVmax-DR and post-SUVmax equally correlate with pathological response.
（18）F-FDG-PET 对评估食管癌新辅助治疗的反应具有潜在的作用。然而，用于评估治疗反应和生存的最佳（18）F-FDG-PET 参数尚未建立。本研究旨在选择两种氟脱氧葡萄糖（（18）F-FDG）-正电子发射断层扫描（PET）参数中的最佳参数：最大标准化摄取量（SUVmax）的降低比值（SUVmax-DR）或治疗后 SUVmax（post-SUVmax）的绝对值，以预测接受新辅助化疗的食管癌患者的反应和生存。
该研究的对象是 211 例连续接受新辅助化疗后行手术治疗的食管癌患者。在新辅助化疗完成前（pre-SUVmax）、完成后 2-3 周（post-SUVmax）进行（18）F-FDG-PET 检查，并测量 SUVmax-DR。
新辅助化疗期间 SUVmax 均值从 11.4 降至 5.8，SUVmax-DR 均值为 49.4%。虽然 post-SUVmax 和 SUVmax-DR 均与病理反应显著相关，但 post-SUVmax 和 SUVmax-DR 均无法区分病理完全缓解和病理良好缓解。SUVmax-DR>50%的患者 5 年生存率明显高于 SUVmax-DR<50%的患者（56.5%比 39.6%，p=0.0137），post-SUVmax<3.5 的患者 5 年生存率明显高于 post-SUVmax>3.5 的患者（62.2%比 35.1%，p<0.0001）。多变量分析显示，新辅助化疗后，post-SUVmax 是独立的预后因素，而不是 SUVmax-DR。
post-SUVmax 对预测接受新辅助治疗后手术治疗的食管癌患者的生存情况更有用，尽管 SUVmax-DR 和 post-SUVmax 与病理反应均有相关性。
