Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, 5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan.
Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Taoyuan, Taiwan.
Eur J Nucl Med Mol Imaging. 2018 May;45(5):689-698. doi: 10.1007/s00259-017-3901-3. Epub 2017 Nov 30.
Our purpose was to examine the prognostic value of post-CRT PET based on the presence or absence of FDG-avid metastatic lymph node(s) and metabolic response of the primary tumor in patients with clinically node-positive ESCC treated with definitive chemoradiotherapy (dCRT).
We identified 108 eligible patients treated by chemoradiotherapy (CRT) with or without resection from our prospectively collected database. Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after initial CRT was defined as the Post-CRT PET favorable group (yPET-F), and otherwise as unfavorable group (yPET-U). The Kaplan-Meier method and Cox regression were performed for survival analyses and multivariable analysis, respectively.
The study cohort was comprised of 59 patients receiving dCRT. Forty-five patients receiving trimodality therapy (TMT) comprised the comparative group and four patients were excluded from further analyses for developing interval distant metastasis detected on post-CRT PET scan. The median follow-up for the study cohort was 41 months. On K-M analysis of the study cohort, yPET-F was found to have significantly better OS (2-year: 72.5% vs 13.7%, p < 0.01) and DMFS (2-year: 71.6% vs 36.6%, p = 0.01) than yPET-U. In multivariable analysis, yPET-F remained as a strong independent favorable prognosticator on both OS (HR 0.08, p < 0.01) and DMFS (HR 0.14, p = 0.02) for the dCRT cohort. Compared with TMT cohort, for yPET-U patients, TMT had better OS (p = 0.03) than dCRT-Operable and dCRT-Operable had superior OS (p = 0.04) than dCRT-Unresectable. For yPET-F patients, there was no difference in both OS (p > 0.99) and DMFS (p = 0.92) between these three groups.
Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after CRT (i.e., yPET-F status) prognosticate for excellent OS and DMFS in cN+ ESCC patients treated with dCRT, and might be comparable to TMT.
本研究旨在探讨在接受根治性放化疗（dCRT）的临床阳性淋巴结食管癌患者中，基于 CRT 后正电子发射断层扫描（PET）中是否存在 FDG 摄取的转移性淋巴结（s）和原发肿瘤的代谢反应，评估 PET 检查的预后价值。
我们从前瞻性收集的数据库中确定了 108 名接受 CRT 治疗（有或无切除）的符合条件的患者。初始 CRT 后 PET 扫描显示原发肿瘤至少部分缓解且无 FDG 摄取的转移性淋巴结定义为 CRT 后 PET 有利组（yPET-F），否则为不利组（yPET-U）。采用 Kaplan-Meier 法和 Cox 回归进行生存分析和多变量分析。
研究队列包括 59 名接受 dCRT 的患者。45 名接受三联疗法（TMT）的患者构成了对照组，有 4 名患者因在 CRT 后 PET 扫描中发现间隔远处转移而被排除在进一步分析之外。研究队列的中位随访时间为 41 个月。在研究队列的 K-M 分析中，yPET-F 患者的 OS（2 年：72.5% vs 13.7%，p<0.01）和 DMFS（2 年：71.6% vs 36.6%，p=0.01）明显优于 yPET-U。在多变量分析中，yPET-F 仍然是 dCRT 队列中 OS（HR 0.08，p<0.01）和 DMFS（HR 0.14，p=0.02）的强有力的独立预后因素。与 TMT 队列相比，对于 yPET-U 患者，TMT 的 OS 优于 dCRT-Operable（p=0.03），dCRT-Operable 的 OS 优于 dCRT-Unresectable（p=0.04）。对于 yPET-F 患者，这三组之间在 OS（p>0.99）和 DMFS（p=0.92）方面均无差异。
在接受 CRT 后 PET 扫描中存在 FDG 摄取的转移性淋巴结（s）且原发肿瘤至少部分缓解（即 yPET-F 状态）的 cN+ 食管癌患者，dCRT 治疗后具有极好的 OS 和 DMFS 预后，与 TMT 相当。
