Park Jin-Soo, Colby Maxwell, Leibman Steven, Laurence Jerome M, Smith Garett, Falk Gregory L, Sandroussi Charbel
Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Notre Dame, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Surgical Outcomes Research Centre, Sydney, Australia.
Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Department of Radiology, Royal North Shore Hospital, Sydney, Australia.
J Gastrointest Surg. 2025 Nov;29(11):102220. doi: 10.1016/j.gassur.2025.102220. Epub 2025 Sep 4.
Currently, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in staging and restaging of esophageal cancer after neoadjuvant therapy. The maximal standardized uptake value (SUVmax) is a reproducible parameter that may predict survival. This study aimed to determine the prognostic significance of SUVmax and the change in SUVmax (ΔSUVmax) after neoadjuvant treatment on overall survival (OS) and disease-free survival (DFS).
FDG-PET data were obtained for patients who underwent radical esophagectomy between 2008 and 2021 across 3 esophageal cancer centers in Sydney, Australia. Receiver operating characteristic curves were used to calculate an optimal cutoff for SUVmax, separating the group into high and low SUVmax and high and low ΔSUVmax.
A total of 344 patients (median age of 67 years, 80.5% male, and 78.7% with adenocarcinomas) with available FDG-PET data were included. The optimal cutoff values for SUVmax and ΔSUVmax were 9.05% and 22%, respectively. Compared with the low SUVmax group, the high SUVmax group had a lower median OS (87.3 vs 54.4 months; P <.001) and a lower median DFS (78.9 vs 42.7 months; P <.001). Compared with the low ΔSUVmax group, the high ΔSUVmax group had a higher median OS (56 vs 62 months; P =.031) but had a similar DFS. In univariate analysis, high SUVmax, high ΔSUVmax, T3 disease, and node negativity were associated with OS. In multivariate analysis, node negativity and ΔSUVmax were independent prognostic factors for OS.
High pretreatment SUVmax was associated with reduced OS and DFS but was not an independent prognostic factor in multivariate analysis. In multivariate analysis, a decrease in SUVmax was an independent prognostic factor. Therefore, quantifiable parameters from FDG-PET are useful for prediction before radical esophagectomy.
目前，18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）广泛应用于新辅助治疗后食管癌的分期及再分期。最大标准化摄取值（SUVmax）是一个可重复的参数，可能预测生存率。本研究旨在确定SUVmax及新辅助治疗后SUVmax的变化（ΔSUVmax）对总生存期（OS）和无病生存期（DFS）的预后意义。
获取了2008年至2021年间在澳大利亚悉尼的3个食管癌中心接受根治性食管切除术患者的FDG-PET数据。采用受试者工作特征曲线计算SUVmax的最佳临界值，将患者分为高SUVmax和低SUVmax以及高ΔSUVmax和低ΔSUVmax组。
共纳入344例有可用FDG-PET数据的患者（中位年龄67岁，80.5%为男性，78.7%为腺癌）。SUVmax和ΔSUVmax的最佳临界值分别为9.05%和22%。与低SUVmax组相比，高SUVmax组的中位OS较低（87.3对54.4个月；P<.001），中位DFS也较低（78.9对42.7个月；P<.001）。与低ΔSUVmax组相比，高ΔSUVmax组的中位OS较高（56对62个月；P=.031），但DFS相似。单因素分析中，高SUVmax、高ΔSUVmax、T3期疾病和淋巴结阴性与OS相关。多因素分析中，淋巴结阴性和ΔSUVmax是OS的独立预后因素。
治疗前高SUVmax与OS和DFS降低相关，但在多因素分析中不是独立的预后因素。多因素分析中，SUVmax降低是独立的预后因素。因此，FDG-PET的可量化参数对根治性食管切除术前的预测有用。
