Investigation of the diagnostic and prognostic impact of posttreatment fluorine-18 fluorodeoxyglucose PET/computed tomography on M0 esophageal cancer.

Abstract

Objective: Fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) is an essential examination to stage patients with esophageal cancer; however, the role of posttreatment [18F]FDG PET/CT in patients with esophageal cancer has not been well explored. We aimed to investigate the prognostic and diagnostic value of posttreatment PET/CT in patients with esophageal cancer after their definitive treatment.

Methods: This retrospective study enrolled 208 patients with biopsy-proven esophageal cancer. Posttreatment PET/CT scans were performed greater than or equal to 3 months after the completion of definitive therapy, with a total of 539 scans included in this study. The outcome measures were the diagnostic capacity of PET/CT and patient survival. Survival analysis was conducted using Kaplan-Meier plots, accompanied by the Mantel-Cox log-rank test and Cox regression.

Results: The sensitivity, specificity, and accuracy of posttreatment PET/CT for recurrent tumors were 93.67, 92.65, and 92.95%, respectively. PET/CT identified recurrent tumors in 24.58% of scans obtained for tumor surveillance and ruled out recurrence in 40.30% of scans obtained with prior clinical suspicion. Negative PET/CT had a predictive value of 80% for nonrecurrence before the next planned scan, while positive PET results were significantly associated with poorer patient survival following the scan ( P < 0.0001). In the multivariate Cox regression model, the PET/CT result was identified as an independent prognostic factor [ P < 0.0001, hazard ratio (HR)=3.818] with a higher hazard ratio compared with the tumor stage ( P = 0.01, HR=1.633) or treatment modality ( P = 0.0002, HR = 2.035).

Conclusion: We illustrate the favorable performance of posttreatment [18F]FDG PET/CT in both detecting tumor recurrence and evaluating the prognosis of patients with M0 esophageal cancer. These findings imply the potential of [18F]FDG PET/CT as a follow-up imaging modality in these patients.