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. 2020 Jun 10;20(1):545.
doi: 10.1186/s12885-020-07044-4.

Prognostic value of lymph node to primary tumor standardized uptake value ratio in unresectable esophageal cancer

Po-Jui Chen  1 , Wing-Keen Yap  1 , Yu-Chuan Chang  2   3 , Chen-Kan Tseng  1 , Yin-Kai Chao  4 , Jason Chia-Hsun Hsieh  5   6 , Ping-Ching Pai  1 , Ching-Hsin Lee  1 , Chan-Keng Yang  5 , Albert Tsung-Ying Ho  2 , Tsung-Min Hung  7   8
Affiliations

Prognostic value of lymph node to primary tumor standardized uptake value ratio in unresectable esophageal cancer

Po-Jui Chen et al. BMC Cancer. .

Abstract

Background: Unresectable esophageal cancer harbors high mortality despite chemoradiotherapy. Better patient selection for more personalized management may result in better treatment outcomes. We presume the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) may provide prognostic information and further stratification of these patients.

Methods: The patients with non-metastatic and unresectable esophageal squamous cell carcinoma (SCC) receiving FDG PET/CT staging and treated by chemoradiotherapy were retrospectively reviewed. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value for NTR. Kaplan-Meier method and Cox regression model were used for survival analyses and multivariable analyses, respectively.

Results: From 2010 to 2016, 96 eligible patients were analyzed. The median follow-up time was 10.2 months (range 1.6 to 83.6 months). Using ROC analysis, the best NTR cut-off value was 0.46 for prediction of distant metastasis. The median distant metastasis-free survival (DMFS) was significantly lower in the high-NTR group (9.5 vs. 22.2 months, p = 0.002) and median overall survival (OS) (9.5 vs. 11.6 months, p = 0.013) was also significantly worse. Multivariable analysis revealed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR] 1.81, p = 0.023) and OS (HR 1.77, p = 0.014).

Conclusions: High pretreatment NTR predicts worse treatment outcomes and could be an easy-to-use and helpful prognostic factor to provide more personalized treatment for patients with non-metastatic and unresectable esophageal SCC.

Keywords: 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG PET); Distant metastasis; Esophageal cancer; Maximum standardized uptake value (SUV); Node-to-tumor SUV ratio (NTR); Personalized treatment; Prognosis; Ratio; Squamous cell carcinoma (SCC); Unresectable.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
ROC (receiver operating characteristic) curve analysis of distant metastasis-free survival prediction according to the node-to-tumor ratio of SUV (NTR). The area under the curve was 0.648 (95% confidence interval [CI] 0.523–0.773). The best NTR cut-off value was 0.46 for prediction of distant metastasis
Fig. 2
Fig. 2
The Kaplan-Meier survival curves of the distant metastasis-free survival (median 9.5 vs. 22.2 months, p = 0.002 by log-rank test) of patients with unresectable esophageal cancer stratified according to node-to-tumor ratio of SUV (NTR) with cut-off value at 0.46
Fig. 3
Fig. 3
The Kaplan-Meier survival curves of the overall survival (median 9.5 vs. 11.6 months, p = 0.013 by log-rank test) of patients with unresectable esophageal cancer stratified according to node-to-tumor ratio of SUV (NTR) with cut-off value at 0.46
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