EUS AND PET-CT RESTAGING FOR ESOPHAGEAL AND GASTRIC ADENOCARCINOMA.COMPARED PERFORMANCE AND SURVIVAL PREDICTION

Aims Our aim was to study whether EUS and PET-CT restaging can predict survival, and their accuracy when correlated to pathologic results.

Methods We conducted a retrospective study on all patients who underwent EUS for gastric or esophageal junction adenocarcinoma staging between 2010 and 2021. EUS and PET-CT were performed in all patients, who also received preoperative TNM restaging by both procedures within 21 days prior surgery. Disease free survival and overall survival were studied. EUS response to neoadjuvant therapy was studied.

Results 185 patients were included,139 males (74.7%). EUS overall accuracy for the distinction of T1-T2 vs. T3-T4 tumors after neoadjuvant therapy was 66.7% (95%CI 50.3%-77.8%; kappa: 0.17); for N staging, accuracy was 70.8% (95%CI: 51.8%-81.8%; kappa 0.39). Regarding PET-CT, we found that N positivity showed an accuracy of 60.4% (CI95%: 46.3%-73%, kappa 0.16). In Kaplan-Meier analysis positive lymph nodes on yUN, and in restaging PET-CT significantly correlated with DFS. Multivariate COX regression analysis found that N restaging with EUS and PET-CT, and Charlson score were correlated with DFS. yUN and PET-CT positive lymph nodes were predictors for OS. In multivariate Cox regression analysis only Charlson score, T response by EUS and male sex were independent risks factors for OS.

Conclusions EUS and PET-CT are suboptimal tools, but the most accurate, to determine esophago-gastric cancer stage. Both techniques have the ability to predict survival, considering N staging and response to neoadjuvant therapy evaluated by EUS as the main predictors.

Publication History

Article published online:
14 April 2022