| Background and objectiveEsophageal cancer is a common malignant tumor of the digestive system in China,with high mortality rate.The main pathological type of esophageal cancer in China is squamous cell carcinoma,and adenocarcinoma and other types are relatively rare.For early localized esophageal cancer,surgical resection is the first choice,and the effect is accurate.For intermediate and advanced esophageal cancer,the 5-year survival rate of simple surgical resection is low.Therefore,radiotherapy and chemotherapy are currently the main method for the treatment of advanced esophageal cancer.The ability to assess prognosis and efficacy at an early stage and further develop individualized treatment plans are of great significance for the survival benefit of patients with esophageal cancer.Patients without surgery rely primarily on imaging to assess prognosis.18F-Fluorodeoxyglucose PET/CT can not only provide tumor anatomy information,but also provide tumor biology information from the perspective of glucose metabolism,and has a good advantage in assessing prognosis.In this study,we retrospectively analyzed the PET metabolic parameters including maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV)and total lesion glycolysis(TLG)of esophageal squamous cell carcinoma patients to explore the value in evaluating the prognosis of esophageal squamous cell carcinoma.MethodsRetrospective analysis of 79 patients diagnosed with esophageal squamous cell carcinoma who underwent PET/CT in the Department of Nuclear Medicine of the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2018.The clinical data of patients such as gender,age,lesion length,clinical stage,and treatment method were collected.All patients underwent 18F-FDG PET/CT within 2 weeks before treatment,and recorded SUVmax.And using SUV=2.5 and 40%SUVmax as the cutoffs,the software automatically drew the region of interest to get MTV2.5,TLG2.5,MTV40%and TLG40%values.To analyze the relationship between PET metabolic parameters and clinical factors of patients,t test,one-way analysis of variance,Mann-Whitney U test and Kruskal-Wallis H test were used to compare the differences between groups.The cutoff value of lesion length and metabolic parameters to predict overall survival(OS)was obtained by the receiver operating characteristic curve(ROC).Univariate survival analysis was performed using the Kaplan-Meier method and Log Rank was used to test for differences between groups.Significant clinical parameters and PET parameters from univariate survival analysis were incorporated into the Cox regression model for multivariate survival analysis.The difference was statistically significant at P<0.05.ResultsA total of 79 patients with esophageal squamous cell carcinoma were included in this study,including 51 males and 28 females,with a median age of 66 years.The survival time was 3 to 66 months,the median survival time was 15 months,and 53 patients died.The values of SUVmax,MTV2.5,TLG2.5,MTV40%,and TLG40%were 17.9±8.45,21.06(11.94,38.39)cm3,140.62(68.01,300.85)g,8.64(3.68,17.52)cm3,83.71(42.13,202.14)g.MTV2.5,TLG2.5,MTV40%,and TLG40%were all related to lesion length,T stage,lymph node metastasis,and clinical stage.But age,gender and tumor site were not related to MTV and TLG.SUVmax was only related to lesion length and T stage.The comparison between groups was statistically significant(P<0.05).The cutoff values of the lesion length,SUVmax,MTV2.5,TLG2.5,MTV40%,and TLG40%predicted by the ROC curve were 5.0cm,12.9,25.54cm3,180.46g,7.46cm3 and 43.88g.Kaplan-Meier survival analysis showed that patients had a better survival time when the lesion length was<5.0cm,MTV2.5<25.54cm3,TLG2,5<180.46g,MTV40%<7.46cm3,and TLG40%<43.88g.Univariate analysis showed that lesion length,MTV2.5,TLG2.5,MTV40%,TLG40%,T stage,lymph node metastasis and clinical stage were prognostic factors of overall survival(P<0.05).Sex,age,primary tumor site,M stage treatment method and SUVmax were not prognostic factors for OS.Cox multivariate regression analysis showed that TLG40%was independent prognostic factor of OS in this study(P=0.001).ConclusionThe PET/CT metabolic volume parameters MTV and TLG before treatment have certain value in predicting the OS of patients.TLG40%is an independent prognostic factor for OS.Clinically,the prognostic risk stratification can be based on the TLG40%value to guide the next step treatment plans to benefit patients’ survival. |
PDF Full Text Request