| Part One: The Study on Clinical Pathological Factors Impacting FDG Uptake of Primary Tumor in Esophageal CarcinomaObjective: Fluorodeoxyglucose-PET is becoming the standard of care in initial staging, monitoring the response to therapy and detection of recurrent esophageal carcinoma. However, the clinical and pathological factors such as age, gender, the length, the depth,the pathological differentiation and lymph node status in relation to this important measurement have not been reported previously.Methods: From June 2004 to November 2006, 68 operable patients with esophageal carcinoma were enrolled in this study. All of them had whole body 18F-fluorodeoxyglucose PET/CT scanned before the operation. The length and depth of invasion, pathological differentiation of the primary lesions, and lymph node metastasis status were determined by postoperative pathology. Tumor uptake was quantitated by maximum standardized uptake value (SUVmax).Results: For the FDG uptake values in the primary lesion, there was a significant statistical difference in different length groups, but not in groups of different genders and ages. There was also a significant statistical difference between low differentiation, intermiddle differentiation and high differentiation groups(r=0.781 , P=0.000). Positive correlation was noticed between the SUVmax and the depth (r=0.860,P=0.000). Furthermore, statistical analysis showed the difference in SUVmax between no lymph node metastasis group and lymph node metastasis group(r=0.852, P=0.000).Conclusion: The primary lesion length, depth and pathological differentiation, but not the age and gender, are related to the FDG uptake in patients with esophageal carcinoma. Increased maximum standardized uptake value in the primary lesion may predict lymph node metastasis at presentation or later stage in esophageal carcinoma.Part Two: The Relationship between PET/CT FDG Uptake of Esophageal Carcinoma Primary Lesions and PrognosisObjective: To investigate the relationship between FDG uptake of esophageal carcinoma primary lesions with prognosis, guide clinical application of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET).Methods: From January 2004 to November 2006, 58 operable patients with esophageal carcinoma were enrolled in this study. All of them had whole body 18F-fluorodeoxyglucose PET/CT scanned before the operation. With 3-dimensional conformal radiotherapy, the total dose whole radiotherapy was 50-60Gy. The chemotherapy was used(5-FU 500mg/㎡ ivdrip Qd×5d, DDP 20mg/㎡ ivdrip Qd×5d). The patient were divided into two groups based the different FDG uptake (SUVmax )of esophageal carcinoma primary lesions. Group A SUVmax≤8, 32 patients were included. while Group B SUVmax>8, 26 patients were included.Results: The 1-,2-,3- year overall survival rate was 92.8﹪,82.7﹪,67.9﹪in the Group A versus 83.3﹪,69.3﹪,50.0﹪in the Group B. With statistical difference between the two groups(P=0.038,0.046,0.041). There is a positive correlation between the SUVmax and prognosis(P=0.000).Conclusion: There is a positive correlation between the SUVmax and prognosis,and FDG-PET can provide additional information on tumor response to chemoradiotherapy.Part Three: The Correlation between 18FDG PET-CT Metabolic Activity Volume and Prognosis in Esophageal CarcinomaObjective: To explore the relationship between tumor prognosis and tumor metabolic activity volume measured by 18F-fluorodeoxyglucose PET/CT in patients with esophageal carcinoma.Methods: From January 2004 to November 2006, 58 operable patients with esophageal carcinoma were enrolled in this study. All of them had whole body 18F-fluorodeoxyglucose PET/CT scanned before the operation. We define the boundary of primory tumor with a absolute SUV of 2.5 as segmentation threshold on PET image, and on the basis of this boundary we calculated the MAV. With 3-dimensional conformal radiotherapy, the total dose whole radiotherapy was 50-60Gy. The chemotherapy was used(5-FU 500mg/㎡ ivdrip Qd×5d, DDP 20mg/㎡ ivdrip Qd×5d). The patients were divided into two groups based the different MAV .Group A1 MAV≤60, 28 patients were included. while Group B1 MAV>60, 30patients were included. The patients were divided into two groups based the different FDG uptake (SUVmax )of esophageal carcinoma primary lesions. Group A2 SUVmax≤8, 32 patients were included. while Group B2 SUVmax > 8, 26 patients were included. the"diameter-SUV index"was calculated by multiplying the tumor diameter by the mean SUV. Group A3 diameter-SUV index≤100, 35 patients were included. while Group B3 diameter-SUV index>100, 23 patients were included.Results: The 1-,2-,3- year overall survival rate was 89.3﹪,82.2﹪,64.3﹪in the Group A1 versus 83.3﹪,70.0﹪,50.0﹪in the Group B1. With statistical difference between the two groups(P=0.052,0.042,0.039). The 1-,2-,3- year overall survival rate was 92.8﹪,82.7﹪,67.9﹪in the Group A2 versus 83.3﹪,69.3﹪,50.0﹪in the Group B2. With statistical difference between the two groups(P=0.038,0.046,0.041). The 1-,2-,3- year overall survival rate was 91.5﹪,85.6﹪,71.4﹪in the Group A3 versus 78.3﹪,60.8﹪,35.5﹪in the Group B3. With statistical difference between the two groups(P=0.035,0.024,0.018). In a Cox regression analysis with inclusion of MAV, SUVmax, diameter-SUV index. The highest accuracy in predicting Prognosis was reached with the diameter–SUV index(P=0.016).Conclusion: The present study shows that the combination of diameter and SUVmean in the"diameter-SUV index"is valuable for predicting tumor survival and treatment response.
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