Trimodality therapy for locally advanced esophageal squamous cell carcinoma: the role of volume-based PET/CT in patient management and prognostication

Abstract

To evaluate the role of positron emission tomography/computed tomography (PET/CT) in predicting pathologic complete response (pCR) and identify relevant prognostic factors from clinico-imaging-pathologic features of locally advanced esophageal squamous cell carcinoma (eSCC) patients undergoing trimodality therapy. We evaluated 275 patients with eSCCs of T3-T4aN0M0 and T1-T4aN1-N3M0 who received trimodality therapy. We correlated volume-based PET/CT parameters before and after concurrent chemoradiation therapy with pCR after surgery, clinico-imaging-pathologic features, and patient survival. pCR occurred in 75 (27.3%) of 275 patients, of whom 61 (80.9%) showed 5-year survival. Pre-total lesion glycolysis (pre-TLG, OR\u2009=\u20090.318, 95% CI 0.169 to 0.600), post-metabolic tumor volume (post-MTV, OR\u2009=\u20090.572, 95% CI 0.327 to 0.999), and % decrease of average standardized uptake value (% SUVavg decrease, OR\u2009=\u20092.976, 95% CI\u2009=\u20091.608 to 5.507) were significant predictors for pCR. Among them, best predictor for pCR was pre-TLG with best cutoff value of 205.67 and with AUC value of 0.591. Performance status (HR\u2009=\u20095.171, 95% CI 1.737 to 15.397), pathologic tumor size (HR\u2009=\u20091.645, 95% CI 1.351 to 2.002), pathologic N status (N1, HR\u2009=\u20091.572, 95% CI 1.010 to 2.446; N2, HR\u2009=\u20093.088, 95% CI 1.845 to 5.166), and post-metabolic tumor volume (HR\u2009=\u20091.506, 95% CI 1.033 to 2.195) were significant predictors of overall survival. Pre-TLG, post-MTV, and % SUVavg decrease are predictive of pCR. Additionally, several clinico-imaging-pathologic factors are significant survival predictors in locally advanced eSCC patients undergoing trimodality therapy.