Suzuki K, Etoh T, Shibata T, Nishiki K, Fumoto S, Ueda Y, Shiroshita H, Shiraishi N, Inomata M. Positron emission tomography complete metabolic response as a favorable prognostic predictor in esophageal cancer following neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil. World J Clin Oncol 2021; 12(4): 249-261 [PMID: 33959478 DOI: 10.5306/wjco.v12.i4.249]
Corresponding Author of This Article
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
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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, 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
ARTICLE HIGHLIGHTS
Research background
Recent studies have shown that 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) can determine the degree of metabolic activity in tumor cells and can improve tumor staging for patients with esophageal cancer. Furthermore, several studies have shown that FDG-PET/computed tomography (CT) (FDG-PET/CT) is useful for diagnosing metastatic lymph nodes and distant metastasis and for detecting the recurrence of esophageal cancer after surgery. However, the value of FDG-PET/CT to predict survival in patients with esophageal cancer is controversial.
Research motivation
Accurate assessment of cancer remnants after neoadjuvant chemotherapy (NAC) in esophageal cancer may lead to a watch-and-see treatment strategy to avoid surgery.
Research objectives
We aimed to evaluate the value of PET complete metabolic response in esophageal cancer following NAC as a prognostic predictor.
Research methods
We reviewed data from 70 consecutive patients with squamous cell esophageal cancer who were preoperatively evaluated with FDG-PET/CT before and after NAC with docetaxel, cisplatin and 5-fluorouracil between June 2013 and December 2017 at Oita University. Those who received definitive radiotherapy/chemotherapy after NAC (n = 11) and underwent esophagectomy in another hospital (n = 1) were excluded. Thus, 58 patients received esophagectomy after NAC and were enrolled in this retrospective cohort study.
Research results
Five-year relapse-free survival and overall survival (OS) in the PET complete metabolic response group were significantly more favorable than those in the non-PET complete metabolic response group (38.6 mo vs 20.8 mo, P = 0.021, 42.8 mo vs 25.1 mo, P = 0.011, respectively). The univariate analysis of OS showed pathologic T, N, M, stage, complete response and CT-PET negative T and N to be statistically significant. Then, the multivariate analysis subsequently selected CT-PET negative N (hazard ratio: 8.268; 95% confidence interval 1.74-63.60; P < 0.01) as the only independent covariate for OS.
Research conclusions
The multivariate analysis subsequently selected CT-PET negative N (hazard ratio: 8.268; 95% confidence interval: 1.74-63.60; P < 0.01) as the only independent covariate for OS.
Research perspectives
In limited patients with PET-negative lymph nodes after NAC, a watch-and-see strategy may be one possible option to avoid unnecessary esophagectomy in the future.
