Prognostic value of metabolic volume measured by F-18 FDG PET-CT in patients with esophageal cancer

Purpose: The aim of this study was to evaluate the usefulness of the metabolic tumor volume (MTV) measured by F-18 Fluorodeoxyglucose positron emission tomography (FDG PET-CT) in predicting recurrence free survival (RFS) in patients with esophageal cancer. Methods: Forty-five patients with squamous cell carcinoma, who had undergone whole-body F-18 FDG PET-CT scans before surgical resection, were included in this study. All patients were treated with Ivor-Lewis esophagectomy. The MTV was quantified within the primary tumor using the 50% threshold of the maximum standardized uptake value (SUVmax) of the FDG uptake areas. The cutoff value of MTV50 was determined through receiver-operating characteristic curve. The Kaplan Meier method was used to find out the relationship between RFS and MTV50. Univariate analysis and multivariate proportional hazards regression analysis were applied to test the significance of volumetric parameter of F-18 FDG PET-CT and other conventional prognostic factors for the prediction of RFS. Results: Overall median follow up period was 17.87 months (range: 1.0763.27 months). The median survival between treatment completion and recurrence was 15.5 months (range: 1.3772.43 months). Recurrence was found in eight patients. On univariate analysis, MTV50 (P = 0.0032), N stage (P = 0.0004), American Joint Committee on Cancer stage (P = 0.0101), tumor location (P = 0.0054) and adjuvant treatment (P = 0.0373) were significant predictors of RFS. Multivariate analysis showed that the independent prognostic factors were MTV50 (P = 0.0465), N stage (P = 0.0303) and tumor location (P = 0.0270). Conclusion: Volume based parameter of F-18 FDG PET-CT may have a role in providing prognostic information in esophageal cancer patients who received esophagectomy.