Chhabra Arpit, Ong Leonard T, Kuk Deborah, Ku Geoffrey, Ilson David, Janjigian Yelena Y, Wu Abraham, Schöder Heiko, Goodman Karyn A
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Br J Cancer. 2015 Dec 22;113(12):1658-65. doi: 10.1038/bjc.2015.416. Epub 2015 Dec 10.
The role of maximum standard uptake value (SUVmax) at baseline and after induction chemotherapy (CT) on positron emission tomography (PET) as an imaging biomarker has not been well established in oesophageal squamous cell carcinoma (SCC). In this retrospective analysis, we investigated the prognostic significance of various PET metrics in oesophageal SCC patients treated with induction chemotherapy followed by concurrent chemoradiotherapy (CRT).
A total of 57 patients were treated with CRT; 52 patients received induction chemotherapy and 10 patients underwent surgery following CRT. Scans were independently analysed by a nuclear medicine physician blinded to patient outcome. Using region of interest analysis, SUVmax and metabolic tumour volume (MTV) were calculated for the index lesion and lymph node metastases in each patient. Kaplan-Meier analysis was used to evaluate overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). Cox proportional hazards regression was used to assess correlation between outcomes and PET metrics.
Median follow-up for those who are alive was 4.4 years, with a median survival for all patients of 2.9 years. The 3-year OS, DFS, DMFS and LRFS rates were 47, 40, 44 and 36%, respectively. Using a pre-established cutoff of a 35% decrease in SUVmax from baseline to post-induction PET, 3-year OS for responders (⩾35% decrease from baseline) was 64%, whereas non-responders (<35% decrease from baseline) had a 3-year OS of 15% (P=0.004).
The pre-specified 35% decrease in SUVmax after induction chemotherapy was prognostic for OS. Baseline and post-induction PET metrics provide prognostic information for oesophageal SCC.
在食管鳞状细胞癌（SCC）中，基线及诱导化疗（CT）后正电子发射断层扫描（PET）的最大标准摄取值（SUVmax）作为一种影像生物标志物的作用尚未完全明确。在这项回顾性分析中，我们研究了多种PET指标在接受诱导化疗后序贯同步放化疗（CRT）的食管SCC患者中的预后意义。
共有57例患者接受了CRT；52例患者接受了诱导化疗，10例患者在CRT后接受了手术。扫描结果由一位对患者预后不知情的核医学医师独立分析。采用感兴趣区分析，计算每位患者指标病变及淋巴结转移灶的SUVmax和代谢肿瘤体积（MTV）。采用Kaplan-Meier分析评估总生存期（OS）、无病生存期（DFS）、局部无复发生存期（LRFS）和远处无转移生存期（DMFS）。采用Cox比例风险回归评估预后与PET指标之间的相关性。
存活患者的中位随访时间为4.4年，所有患者的中位生存期为2.9年。3年OS、DFS、DMFS和LRFS率分别为47%、40%、44%和36%。采用预先设定的从基线到诱导后PET的SUVmax降低35%的临界值，反应者（从基线降低⩾35%）的3年OS为64%，而无反应者（从基线降低<35%）的3年OS为15%（P=0.004）。
诱导化疗后预先设定的SUVmax降低35%对OS具有预后意义。基线及诱导后PET指标可为食管SCC提供预后信息。
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