Association between prognosis and lymph node status using ¹⁸F‐fluorodeoxyglucose‐positron emission tomography in esophageal squamous cell carcinoma treated with esophagectomy post‐neoadjuvant chemotherapy

Abstract

BackgroundThere are few reports on the associations between lymph node (LN) status, determined by preoperative 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET), and prognosis in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy post‐neoadjuvant chemotherapy (NCT). Additionally, details on the diagnostic performance of LN metastasis determination based on pathological examination versus FDG‐PET have not been reported. In this study, we aimed to evaluate the associations among LN status using FDG‐PET, LN status based on pathological examination, and prognosis in patients with locally advanced ESCC who underwent esophagectomy post‐NCT.MethodsWe reviewed the data of 124 consecutive patients with ESCC who underwent esophagectomy with R0 resection post‐NCT between December 2008 and August 2022 and were evaluated pre‐ and post‐NCT using FDG‐PET. The associations among LN status using FDG‐PET, LN status based on pathological examination, and prognosis were assessed.ResultsStation‐by‐station analysis of PET‐positive LNs pre‐ and post‐NCT correlated significantly with pathological LN metastases (sensitivity, specificity, and accuracy pre‐ and post‐NCT: 51.6%, 96.0%, and 92.1%; and 28.2%, 99.5%, and 93.1%, respectively; both p < 0.0001). Using univariate and multivariate analyses, LN status determined using PET post‐NCT was a significant independent predictor of both recurrence‐free survival and overall survival.ConclusionThe LN status assessed using FDG‐PET post‐NCT was significantly associated with the pathological LN status and prognosis in patients with ESCC who underwent esophagectomy post‐NCT. Therefore, FDG‐PET is a useful diagnostic tool for preoperatively predicting pathological LN metastasis and survival in these patients and could provide valuable information for selecting individualized treatment strategies.