ASO Author Reflections: Prediction of Pathological Features of Esophageal Cancer Using FDG-PET
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Prediction of Pathological Features of Esophageal Cancer Using FDG-PET Yoichi Hamai, MD, PhD Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
PAST Patients with locally advanced esophageal cancer often undergo trimodal therapy comprising neoadjuvant chemoradiotherapy (NCRT) followed by surgery. Prognoses after trimodal therapy correlate with various pathological factors, such as tumor depth, lymph node metastasis, lymphovascular invasion, and pathological tumor response.1 The degree of metabolic activity in tumor cells can be determined by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), and FDG-PET can differentiate pathological responders from non-responders to neoadjuvant therapy.2 However, associations between other pathological features and FDG uptake (maximal standardized uptake value [SUVmax]) by primary tumors in locally advanced esophageal cancer have not been investigated in detail. If malignant aggressive behavior could be predicted using preoperative FDG-PET, then treatment strategies could be optimized and the prognosis of esophageal cancer might also become more predictable. Therefore, relationships between FDG uptake in primary tumors on preoperative FDG-PET images and pathological features, and esophageal cancer recurrence after trimodal therapy, should be investigated. PRESENT An evaluation of relationships between the SUVmax of primary tumors on preoperative FDG-PET and pathological features and recurrence in 143 patients with esophageal
Ó Society of Surgical Oncology 2020 First Received: 9 May 2020 Y. Hamai, MD, PhD e-mail: [email protected]
squamous cell carcinoma (ESCC) who underwent NCRT followed by surgery has generated important findings.3 The SUVmax after NCRT significantly differs for ypT and ypN status, lymphatic invasion (LI), venous invasion (VI) and recurrence. Furthermore, the %DSUVmax (rate of decrease between before and after NCRT) for LI, VI, and recurrence also significantly differs. Post-SUVmax and %DSUVmax are independent preoperative predictors of recurrence-free survival (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.24–1.72; and HR 0.97, 95% CI 0.96–0.99, respectively; p \ 0.001 for both). Recurrence-free and overall survival rates can be significantly stratified according to optimal SUVmax cut-offs for predicting recurrence. Thus, FDG-PET can preoperatively predict the degree of aggressive ESCC behavior in patients after trimodal therapy. FUTURE FDG-PET allows the metabolic assessment of tumors, with considerable diagnostic improvement, which can positively impact the design of treatment strategies, the assessment of therapeutic responses, and predict the prognosis of esophageal cancer. However, the optimal timing, evaluation methods, and cut-off values for using FDG-PET to diagnose the status of esophageal cancer after trimodal therapy have not yet reached consensus.4 Furthermore, interobserver variability in FDG-PET assessments among multiple sites and evaluators might be pro
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