Lee Hyunjong, Lee Kyung Soo, Min Yang Won, Kim Hong Kwan, Zo Jae Ill, Shim Young Mog, Choi Joon Young
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Oncol. 2022 Jun 30;12:861867. doi: 10.3389/fonc.2022.861867. eCollection 2022.
Recently, the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system was updated for its 8th edition. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a useful imaging tool to diagnose and predict prognoses for esophageal cancer. However, there was no previous study to explore the role of FDG PET/CT in the staging system based on the 8th edition. The prognostic value of FDG PET/CT was investigated in patients with esophageal squamous cell carcinoma (SqCC) considering the new 8th AJCC/UICC staging system.
Subjects were 721 patients with esophageal SqCC undergoing pretherapeutic FDG PET/CT. Clinico-pathological variables and the maximum standardized uptake value (SUVmax) of the primary tumor were included in survival analysis. Subgroup analysis was performed to compare hazard ratios according to pathological stage and SUVmax. A new staging classification including FDG uptake was proposed.
In multivariate survival analysis, pathological stage and SUVmax of the primary tumor were selected as independent prognostic factors for overall survival in both the 7th and 8th editions. The proposed new staging system showed better discrimination for overall survival between stage I and II than did the conventional staging system (hazard ratios: 2.250 vs. 1.341).
The FDG uptake of the primary tumor was found to be an independent prognostic factor along with pathological stage based on both 7th and 8th AJCC/UICC staging systems in patients with esophageal SqCC. The suggested new staging system including SUVmax was better for predicting prognoses than the conventional staging system.
最近，美国癌症联合委员会（AJCC）/国际癌症控制联盟（UICC）分期系统更新至第8版。F-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）是诊断和预测食管癌预后的一种有用的影像学工具。然而，此前尚无研究探讨FDG PET/CT在基于第8版的分期系统中的作用。考虑到新的第8版AJCC/UICC分期系统，对食管鳞状细胞癌（SqCC）患者的FDG PET/CT的预后价值进行了研究。
研究对象为721例接受治疗前FDG PET/CT检查的食管SqCC患者。生存分析纳入了临床病理变量和原发肿瘤的最大标准化摄取值（SUVmax）。进行亚组分析以比较根据病理分期和SUVmax的风险比。提出了一种包括FDG摄取的新分期分类。
在多因素生存分析中，原发肿瘤的病理分期和SUVmax被选为第7版和第8版总体生存的独立预后因素。与传统分期系统相比，新提出的分期系统在I期和II期之间对总体生存的区分度更好（风险比：2.250对1.341）。
在食管SqCC患者中，基于第7版和第8版AJCC/UICC分期系统，原发肿瘤的FDG摄取与病理分期一样是独立的预后因素。包括SUVmax的新分期系统在预测预后方面比传统分期系统更好。
