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. 2023 May;128(10):1879-1887.
doi: 10.1038/s41416-023-02151-y. Epub 2023 Feb 25.

Risk stratification of oesophageal squamous cell carcinoma using change in total lesion glycolysis and number of PET-positive lymph nodes

Yohei Nose  1 , Tomoki Makino  2 , Mitsuaki Tatsumi  3 , Koji Tanaka  1 , Kotaro Yamashita  1 , Toshiki Noma  1 , Takuro Saito  1 , Kazuyoshi Yamamoto  1 , Tsuyoshi Takahashi  1 , Yukinori Kurokawa  1 , Kiyokazu Nakajima  1 , Hidetoshi Eguchi  1 , Yuichiro Doki  1
Affiliations

Risk stratification of oesophageal squamous cell carcinoma using change in total lesion glycolysis and number of PET-positive lymph nodes

Yohei Nose et al. Br J Cancer. 2023 May.

Abstract

Background: The efficacy of neoadjuvant chemotherapy (NACT) correlates with patient survival in oesophageal squamous cell carcinoma (OSCC), but optimal evaluation of the treatment response based on PET-CT parameters has not been established.

Methods: We analysed 226 OSCC patients who underwent PET-CT before and after NACT followed by surgery. We assessed SUVmax, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) for the primary tumour and the number of PET-positive lymph nodes before and after NACT to predict patient survival.

Results: In a stepwise analysis, we defined 60%, 80%, and 80% as the optimal cut-off values for SUVmax, MTV, and TLG reduction, respectively, to distinguish responders and non-responders to NACT. In the ROC analysis, the TLG reduction rate was the best predictor of recurrence among PET-CT parameters. The TLG responders achieved significantly more favourable prognoses than non-responders (2-year progression-free survival [PFS] rate: 64.1% vs. 38.5%; P = 0.0001). TLG reduction rate (HR 2.58; 95% CI 1.16-5.73) and the number of PET-positive lymph nodes after NACT (HR 1.79; 95% CI 1.04-3.08) were significant independent prognostic factors.

Conclusions: TLG reduction is the best predictor of prognosis. Preoperative PET-CT evaluation of both the primary tumour and lymph nodes could accurately stratify risk in OSCC patients.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Receiver operating characteristic (ROC) analysis of postoperative recurrence.
The area under the curve (AUC) and cut-off for each PET-CT indicator are shown.
Fig. 2
Fig. 2. Progression-free survival (PFS) classified by the total lesion glycolysis (TLG) reduction rate in the primary tumour during neoadjuvant chemotherapy.
a The TLG responders (TLG reduction rate ≥80%) achieved significantly more favourable prognoses than non-responders (TLG reduction rate <80%). Two-year PFS rate: 64.1 vs. 38.5%, P = 0.0001. b When classified into three groups according to TLG reduction rate (80–100%, 60–80%, <60%), 2-year PFS rates were 64.1%, 46.3%, and 29.9%, respectively.
Fig. 3
Fig. 3. Kaplan–Meier analysis of progression-free survival (PFS).
a For all patients classified into four groups based on the total lesion glycolysis (TLG) reduction rate and number of post-NACT PET-positive lymph nodes (PET-N). b For all patients classified into four groups based on TLG reduction rate and pN.
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