Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 24, 2021; 12(4): 249-261
Published online Apr 24, 2021. doi: 10.5306/wjco.v12.i4.249
Positron emission tomography complete metabolic response as a favorable prognostic predictor in esophageal cancer following neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil
Kosuke Suzuki, Tsuyoshi Etoh, Tomotaka Shibata, Kohei Nishiki, Shoichi Fumoto, Yoshitake Ueda, Hidefumi Shiroshita, Norio Shiraishi, Masafumi Inomata
Kosuke Suzuki, Tsuyoshi Etoh, Tomotaka Shibata, Yoshitake Ueda, Hidefumi Shiroshita, Norio Shiraishi, Masafumi Inomata, Department of Gastroenterological and Pediatric Surgery, Oita University, Yufu 879-5593, Oita, Japan
Kohei Nishiki, Shoichi Fumoto, Department of Surgery, Oita Nakamura Hospital, Oita 870-0022, Japan
Author contributions: Suzuki K, Etoh T, Shibata T and Inomata M contributed to conception and design; Suzuki K, Etoh T, Nishiki K, Fumoto S, Ueda Y, Shiroshita H and Shiraishi N contributed to literature search, acquisition, analysis and interpretation; Suzuki K and Etoh T are responsible for drafting and revising the manuscript; All authors affirm final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Institutional review board statement: This study was approved by the institutional Ethical Review Board of Oita University Faculty of Medicine (Approval No. 1602).
Informed consent statement: Informed consent of this study is shown in HP of Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine (http://www.surgery1.med.oita-u.ac.jp).
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Please contact to Suzuki K (kosuzuki@oita-u.ac.jp) to get the data of this study.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kosuke Suzuki, PhD, Assistant Professor, Department of Gastroenterological and Pediatric Surgery, Oita University, 1-1 Idaigaoka, Hasama, Yufu 879-5593, Oita, Japan. kosuzuki@oita-u.ac.jp
Received: September 21, 2020
Peer-review started: September 21, 2020
First decision: November 16, 2020
Revised: November 25, 2020
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 24, 2021
Abstract
BACKGROUND

18F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography is useful in diagnosing lymph node and distant metastases of esophageal cancer. However, its value for predicting survival is controversial.

AIM

To evaluate the value of PET complete metabolic response (CMR) as a prognostic predictor for esophageal cancer.

METHODS

Between June 2013 and December 2017, 58 patients with squamous cell esophageal cancer who underwent neoadjuvant chemotherapy (NAC) in Oita University were enrolled in this retrospective cohort study. Tumors were clinically staged using fluorodeoxyglucose-PET/computed tomography before and after NAC. After NAC, maximal standardized uptake value ≤ 2.5 was defined as PET-CMR, and maximal standardized uptake value > 2.5 was defined as non-PET-CMR. We compared short-term outcomes between the PET-CMR group and non-PET-CMR group and evaluated prognostic factors by univariate and multivariate analyses.

RESULTS

The PET-CMR group included 22 patients, and the non-PET-CMR group included 36 patients. There were no significant differences in intraoperative and postoperative complications between the two groups. Five-year relapse-free survival and overall survival in the PET-CMR group were significantly more favorable than those in the non-PET-CMR group (38.6 mo vs 20.8 mo, P = 0.021; 42.8 mo vs 25.1 mo, P = 0.011, respectively). PET-CMR was a significant prognostic factor in terms of relapse-free survival by univariate analysis (hazard ratio: 2.523; 95% confidence interval: 1.034–7.063; P < 0.041). Particularly, PET-computed tomography negative N was an independent prognostic factor of relapse-free survival and overall survival by multivariate analysis.

CONCLUSION

PET-CMR after NAC is considered a favorable prognostic factor for esophageal cancer. Evaluation by PET-computed tomography could be useful in clinical decision making for esophageal cancer.

Keywords: Esophageal cancer, Neoadjuvant chemotherapy, Positron emission tomography/computed tomography, Complete metabolic response, Prognostic factor, Docetaxel, cisplatin plus 5-fluorouracil

Core Tip: The study aimed to evaluate the value of positron emission tomography (PET)/computed tomography complete metabolic response (CMR) as a prognostic predictor for esophageal cancer. Fifty-eight patients with esophageal cancer who underwent neoadjuvant chemotherapy were enrolled. The PET-CMR group included 22 patients, and the non-PET-CMR group included 36 patients. Five-year relapse-free survival and overall survival in the PET-CMR group were significantly more favorable than those in the non-PET-CMR group. PET-CMR was a significant prognostic factor in terms of relapse-free survival by univariate analysis. PET-CMR after neoadjuvant chemotherapy is considered a favorable prognostic factor for relapse-free survival in patients with esophageal cancer.