Prediction of Recurrence and Mortality of Locally Advanced Esophageal Cancer Patients Using Pretreatment F-18 FDG PET/CT Parameters: Intratumoral Heterogeneity, SUV, and Volumetric Parameters.

Objective: This study was aimed to define the predictive values of preoperative Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) parameters and compared to define effective parameters for prediction of overall survival (OS) and recurrent free survival (RFS) in locally advanced esophageal cancer (LAEC).

Methods: This study included 44 patients with LAEC who received F-18 FDG PET/CT. Univariate and multivariate analyses were used to calculate survival, and the survival curves were estimated by clinical factors and F-18 FDG PET/CT-derived parameters.

Results: Higher values of F-18 FDG PET/CT parameters (SUVmax, SUVmean, metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and advanced tumor-node-metastasis (TNM) staging showed higher mortality. The Cox proportional hazard regression model demonstrated advanced TNM stage and high MTV as poor OS factors. The early TNM stage, lower MTV, lower TLG, lymph node (LN) (-), and lower heterogeneity factor (HF) were also associated with better RFS. The MTV was the potent predictor for RFS.

Conclusions: In conclusion, although the newly described parameter of HF measured by F-18 FDG PET/CT could be a prognostic factor, the MTV is the most potent prognostic predictor in LAEC.