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Thorac Cardiovasc Surg 2015; 63(04): 341-348
DOI: 10.1055/s-0034-1384787
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Prognostic Value of the Maximum Standardized Uptake Value on Positron Emission Tomography for Esophageal Squamous Cell Carcinoma

Hyun Woo Jeon
1   Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
,
Kyung Soo Kim
2   Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Sook Whan Sung
2   Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Hyung Joo Park
2   Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Young-Du Kim
1   Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
,
Jae Kil Park
2   Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

23 January 2014

09 May 2014

Publication Date:
16 October 2014 (online)

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Abstract

Background Esophageal cancer is a malignant tumor with one of the worst prognosis. Positron emission tomography (PET) reveals the degree of metabolic activity of tumor cells. We hypothesized that a high maximum standardized uptake value (SUVmax) on PET would predict a poor clinical outcome.

Methods From November 2004 to August 2011, we reviewed 88 patients with esophageal squamous cell carcinoma who underwent preoperative PET followed by surgery. SUVmax values of primary sites were measured. The patients were divided into two groups with median SUVmax as a cutoff value and outcomes were compared.

Results The median SUVmax was 6.35. Cervical and upper thoracic cancer, large tumor size, stage ≥ T2, and lymph node metastasis were significantly associated with the high SUVmax group. Cervical and upper thoracic cancer (p = 0.038), SUVmax (p = 0.038), number of lymph nodes dissected (p = 0.009), stage ≥ T2 (p = 0.003), lymph node metastasis (p < 0.001), and incomplete resection (p = 0.031) were significant predictors for the disease-free survival. A high SUVmax ( ≥ 6.35, p = 0.023) and stage ≥ T2 (p = 0.025) were significantly associated with overall survival by multivariate analysis.

Conclusion High preoperative SUVmax on PET predicts advanced T stage and worse prognosis. SUVmax on PET may provide useful information combined with current stage for determining optimal treatment in esophageal cancer.

Keywords

esophageal surgery - cancer - tumor - positron emission tomography
 

  • References

  • 1 Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60 (5) 277-300
    CrossrefPubMedGoogle Scholar
  • 2 Mawhinney MR, Glasgow RE. Current treatment options for the management of esophageal cancer. Cancer Manag Res 2012; 4: 367-377
    PubMedGoogle Scholar
  • 3 Lund O, Hasenkam JM, Aagaard MT, Kimose HH. Time-related changes in characteristics of prognostic significance in carcinomas of the oesophagus and cardia. Br J Surg 1989; 76 (12) 1301-1307
    CrossrefPubMedGoogle Scholar
  • 4 Meltzer CC, Luketich JD, Friedman D , et al. Whole-body FDG positron emission tomographic imaging for staging esophageal cancer comparison with computed tomography. Clin Nucl Med 2000; 25 (11) 882-887
    CrossrefPubMedGoogle Scholar
  • 5 Luketich JD, Schauer PR, Meltzer CC , et al. Role of positron emission tomography in staging esophageal cancer. Ann Thorac Surg 1997; 64 (3) 765-769
    CrossrefPubMedGoogle Scholar
  • 6 Fukunaga T, Okazumi S, Koide Y, Isono K, Imazeki K. Evaluation of esophageal cancers using fluorine-18-fluorodeoxyglucose PET. J Nucl Med 1998; 39 (6) 1002-1007
    PubMedGoogle Scholar
  • 7 Choi JY, Jang HJ, Shim YM , et al. 18F-FDG PET in patients with esophageal squamous cell carcinoma undergoing curative surgery: prognostic implications. J Nucl Med 2004; 45 (11) 1843-1850
    PubMedGoogle Scholar
  • 8 Cerfolio RJ, Bryant AS. Maximum standardized uptake values on positron emission tomography of esophageal cancer predicts stage, tumor biology, and survival. Ann Thorac Surg 2006; 82 (2) 391-394 , discussion 394–395
    CrossrefPubMedGoogle Scholar
  • 9 Rice TW, Rusch VW, Ishwaran H, Blackstone EH. Worldwide Esophageal Cancer Collaboration. Cancer of the esophagus and esophagogastric junction: data-driven staging for the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Cancer Staging Manuals. Cancer 2010; 116 (16) 3763-3773
    CrossrefPubMedGoogle Scholar
  • 10 Räsänen JV, Sihvo EI, Knuuti MJ , et al. Prospective analysis of accuracy of positron emission tomography, computed tomography, and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and the esophagogastric junction. Ann Surg Oncol 2003; 10 (8) 954-960
    CrossrefPubMedGoogle Scholar
  • 11 Lowe VJ, Booya F, Fletcher JG , et al. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol 2005; 7 (6) 422-430
    CrossrefPubMedGoogle Scholar
  • 12 Shimpi RA, George J, Jowell P, Gress FG. Staging of esophageal cancer by EUS: staging accuracy revisited. Gastrointest Endosc 2007; 66 (3) 475-482
    CrossrefPubMedGoogle Scholar
  • 13 Downey RJ, Akhurst T, Ilson D , et al. Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: results of a prospective trial. J Clin Oncol 2003; 21 (3) 428-432
    CrossrefPubMedGoogle Scholar
  • 14 van Vliet EP, Heijenbrok-Kal MH, Hunink MG, Kuipers EJ, Siersema PD. Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer 2008; 98 (3) 547-557
    CrossrefPubMedGoogle Scholar
  • 15 Al-Sarraf N, Gately K, Lucey J , et al. Clinical implication and prognostic significance of standardised uptake value of primary non-small cell lung cancer on positron emission tomography: analysis of 176 cases. Eur J Cardiothorac Surg 2008; 34 (4) 892-897
    CrossrefPubMedGoogle Scholar
  • 16 Paesmans M, Berghmans T, Dusart M , et al; European Lung Cancer Working Party, and on behalf of the IASLC Lung Cancer Staging Project. Primary tumor standardized uptake value measured on fluorodeoxyglucose positron emission tomography is of prognostic value for survival in non-small cell lung cancer: update of a systematic review and meta-analysis by the European Lung Cancer Working Party for the International Association for the Study of Lung Cancer Staging Project. J Thorac Oncol 2010; 5 (5) 612-619
    PubMedGoogle Scholar
  • 17 van Westreenen HL, Plukker JT, Cobben DC, Verhoogt CJ, Groen H, Jager PL. Prognostic value of the standardized uptake value in esophageal cancer. AJR Am J Roentgenol 2005; 185 (2) 436-440
    CrossrefPubMedGoogle Scholar
  • 18 Rizk N, Downey RJ, Akhurst T , et al. Preoperative 18[F]-fluorodeoxyglucose positron emission tomography standardized uptake values predict survival after esophageal adenocarcinoma resection. Ann Thorac Surg 2006; 81 (3) 1076-1081
    CrossrefPubMedGoogle Scholar
  • 19 Siewert JR, Ott K. Are squamous and adenocarcinomas of the esophagus the same disease?. Semin Radiat Oncol 2007; 17 (1) 38-44
    CrossrefPubMedGoogle Scholar
  • 20 Kato H, Kuwano H, Nakajima M , et al. Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer 2002; 94 (4) 921-928
    CrossrefPubMedGoogle Scholar
  • 21 Chung HW, Lee KH, Lee EJ , et al. Comparison of uptake characteristics and prognostic value of 201Tl and 18F-FDG in esophageal cancer. World J Surg 2008; 32 (1) 69-75
    CrossrefPubMedGoogle Scholar
  • 22 Pan L, Gu P, Huang G, Xue H, Wu S. Prognostic significance of SUV on PET/CT in patients with esophageal cancer: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2009; 21 (9) 1008-1015
    CrossrefPubMedGoogle Scholar
  • 23 Kato H, Nakajima M, Sohda M , et al. The clinical application of (18)F-fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer. Cancer 2009; 115 (14) 3196-3203
    CrossrefPubMedGoogle Scholar
  • 24 Song IH, Cho S, Yang HC, Jheon S. The role of maximum standardized uptake value in PET/CT as a prognostic factor in patients with resected esophageal squamous cell carcinoma. Thorac Cardiovasc Surg 2014; 62 [Epub ahead of print]
    PubMedGoogle Scholar
  • 25 Manabe O, Hattori N, Hirata K , et al. Diagnostic accuracy of lymph node metastasis depends on metabolic activity of the primary lesion in thoracic squamous esophageal cancer. J Nucl Med 2013; 54 (5) 670-676
    CrossrefPubMedGoogle Scholar
  • 26 Huang HT, Wang F, Shen L, Xia CQ, Lu CX, Zhong CJ. Clinical outcome of middle thoracic esophageal cancer with intrathoracic or cervical anastomosis. Thorac Cardiovasc Surg 2014; ; [Epub ahead of print]
    PubMedGoogle Scholar