Correlation between metabolic response determined with [18F]FDG PET/CT and pathological response after neoadjuvant treatment and surgery in patients with esophageal cancer

Abstract

Aim

To assess the correlation between the result of the PET/CT study with [¹⁸F]FDG and the histological outcome in patients with esophageal cancer undergoing chemoradiotherapy and subsequent surgery.

Material and methods

41 patients (35 men) diagnosed with esophageal cancer during a 10-year interval were retrospectively evaluated. PERCIST criteria and SULpeak (ΔSULpeak) variation between pre- and post-treatment PET/CT studies were used. After neoadjuvant treatment and subsequent surgery, histological response and patient survival were determined, correlating the findings with the result of the metabolic study. Different parameters related to patient and tumors lesion characteristics were compared with respect to histologic response. ROC curves and the Kaplan-Meier method were applied for the analysis of prognostic factors and survival curves.

Results

The mean follow-up was 34.9 months, with 21 relapses-progressions and 25 deaths. Significant differences were demonstrated between histologic responses regarding PERCIST criteria and ΔSULpeak. Both showed adequate sensitivity and moderate specificity in relation to their histological correlation. No significant differences were found with respect to other parameters studied. Survival analysis showed significantly different progression-free survival curves for the ΔSULpeak and histologic outcome.

Conclusion

PERCIST criteria and ΔSULpeak differentiated between patients with and without histological response. ΔSULpeak and histological results proved to be prognostic factors. The results could help to personalize treatment and, together with other determinations, allow an active surveillance approach could be contemplated.