Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
Institute of Medical Informatics, Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
Sci Rep. 2022 May 3;12(1):7148. doi: 10.1038/s41598-022-11076-0.
Aim of this study was to validate the prognostic impact of clinical parameters and baseline F-FDG-PET/CT derived textural features to predict histopathologic response and survival in patients with esophageal squamous cell carcinoma undergoing neoadjuvant chemoradiation (nCRT) and surgery. Between 2005 and 2014, 38 ESCC were treated with nCRT and surgery. For all patients, the F-FDG-PET-derived parameters metabolic tumor volume (MTV), SUVmax, contrast and busyness were calculated for the primary tumor using a SUV-threshold of 3. The parameter uniformity was calculated using contrast-enhanced computed tomography. Based on histopathological response to nCRT, patients were classified as good responders (< 10% residual tumor) (R) or non-responders (≥ 10% residual tumor) (NR). Regression analyses were used to analyse the association of clinical parameters and imaging parameters with treatment response and overall survival (OS). Good response to nCRT was seen in 27 patients (71.1%) and non-response was seen in 11 patients (28.9%). Grading was the only parameter predicting response to nCRT (Odds Ratio (OR) = 0.188, 95% CI: 0.040-0.883; p = 0.034). No association with histopathologic treatment response was seen for any of the evaluated imaging parameters including SUVmax, MTV, busyness, contrast and uniformity. Using multivariate Cox-regression analysis, the heterogeneity parameters busyness (Hazard Ratio (HR) = 1.424, 95% CI: 1.044-1.943; p = 0.026) and contrast (HR = 6.678, 95% CI: 1.969-22.643; p = 0.002) were independently associated with OS, while no independent association with OS was seen for SUVmax and MTV. In patients with ESCC undergoing nCRT and surgery, baseline F-FDG-PET/CT derived parameters could not predict histopathologic response to nCRT. However, the PET/CT derived features busyness and contrast were independently associated with OS and should be further investigated.
本研究旨在验证临床参数和基线 F-FDG-PET/CT 纹理特征对接受新辅助放化疗（nCRT）和手术的食管鳞癌患者的组织病理学反应和生存的预后影响。2005 年至 2014 年间，38 例 ESCC 患者接受了 nCRT 和手术治疗。对所有患者，使用 SUV 阈值为 3 计算原发肿瘤的 F-FDG-PET 衍生参数代谢肿瘤体积（MTV）、SUVmax、对比度和忙碌度。使用对比增强 CT 计算均匀性参数。根据 nCRT 治疗的组织病理学反应，将患者分为良好反应者（<10%残留肿瘤）（R）或无反应者（≥10%残留肿瘤）（NR）。回归分析用于分析临床参数和影像学参数与治疗反应和总生存期（OS）的相关性。27 例患者（71.1%）对 nCRT 有良好反应，11 例患者（28.9%）无反应。分级是唯一预测 nCRT 反应的参数（优势比（OR）=0.188，95%CI：0.040-0.883；p=0.034）。评估的影像学参数包括 SUVmax、MTV、忙碌度、对比度和均匀性，均与组织病理学治疗反应无相关性。使用多变量 Cox 回归分析，异质性参数忙碌度（HR=1.424，95%CI：1.044-1.943；p=0.026）和对比度（HR=6.678，95%CI：1.969-22.643；p=0.002）与 OS 独立相关，而 SUVmax 和 MTV 与 OS 无独立相关性。在接受 nCRT 和手术的 ESCC 患者中，基线 F-FDG-PET/CT 衍生参数无法预测 nCRT 的组织病理学反应。然而，PET/CT 衍生特征忙碌度和对比度与 OS 独立相关，应进一步研究。
