| PurposeEsophageal cancer is the eighth most common cancer and the sixth leading cause of cancer-related mortality worldwide.For patients in early stage of esophageal cancer,surgery is the primary patterns of treatment.However,more than 50%of patients with esophageal cancer have been in the middle or late stage at the time of diagnosis,losing the chance of surgery,and chemo-radiotherapy is the main treatment method for them.Regarding this part of patients,early prediction of tumor response is very helpful,which is beneficial to optimize the treatment strategy in time,thus to improve the local control rate and the survival rate.This is the first study that focused on both abnormal glucose metabolism of tumor cells and the anti-tumor immune response of the host.We explored the predictive value of baseline SUVmax combined with peripheral LMR in patients with esophagus cancer undergoing CRT.MethodsBetween January 2011 and December 2016,138 newly diagnosed ESCC patients Shandong Cancer Hospital and Institute were retrospectively recruited.we extracted the baseline characteristics of PET/CT metabolic parameters(SUVmax,SUVmean,MTV,TLG)and immune index of peripheral blood(absolute lymphocytes count,absolute Monocyte count,absolute neutrophils count,lymphocytes-Monocyte ratio,lymphocytes-neutrophils ratio).All analyses were performed with SPSS 22.0 program(SPSS Inc,Chicago,IL,USA),and a two-sided P-value less than 0.05 was considered statistical significance.The optimal cut-off value of each continuous variable was determined by ROC curve,and the optimum metabolic parameter and immune indexes were selected.According to the selected metabolic parameters and immune indexes,construct different metabolic-immune phenotypes.Using chi-square test or Fisher’s exact test to analyze the statistical differences between the groups,Logistic regression analysis was performed to analyze the factors that may affect the short-term efficacy of patients.Then establish a prediction model based on multivariate analysis result.ResultsBased on the ROC curve,as Single factor predicting the short-term efficacy of chemoradiotherapy for esophageal cancer patients,the optimum parameter of metabolic parameters were SUVmax and SUVmean,the optimum parameter of Peripheral blood were LMR and LNR.The optimal cut-off value of baseline SUVmax was 11.90 and 2.76,respectively,according to the ROC curve.The objective response rate(ORR)was statistically significant between the high-SUVmax group and the low-SUVmax group(60/96,62.5%vs 37/42,88.1%;P=0.002),as well as in the high-LMR group and the low-LMR group(71/88,80.7%vs 26/54,52.0%;P=0.001).Furthermore,Based on the optimal cut-off values of SUVmax and LMR,we divided the patients into four different groups,namely High SUVmax-high LMR group(n=61),high SUVmax-low LMR group(n=35),low SUVmax-high LMR group(n=27),low SUVmax-low LMR group(n=15).The difference of ORR between the four groups was statistically significant(P<0.001).The low SUVmax-high LMR group could get the best ORR,at 100%,which was significantly different from the high SUVmax-high LMR group(ORR:72.1%,P=0.002),the high SUVmax-low LMR group(ORR:45.7%,P=0.001),and the low SUVmax-low LMR group(ORR:45.7%,P=0.001),respectively.Univariate and multivariate analysis showed that tumor staging,treatment mode,SUVmax and LMR were independent predictors of the short-term efficacy of esophageal cancer.The prediction model formed by using these four parameters has a good prediction effect;with an AUC was 0.792;sensitivity and specificity were 71.1%and 73.2%,respectively.ConclusionBaseline SUVmax of primary tumor and peripheral LMR were independent predictors for primary tumor response of CRT in ESCC patients.Patients who had lower FDG uptake accompany with higher peripheral LMR are more likely to have better primary tumor response after CRT,while those who had higher FDG uptake accompany with lower peripheral LMR are more likely to have a poor one.This may helpful to classify patients before treatment,and then take individualized treatment. |
PDF Full Text Request