Abstract. Positron emission tomography/computed tomography (PET/CT) with 18 F-fluoro-2-deoxyglucose (FDG-PET/CT) has become established in cancer imaging, and derived maximum standardized uptake values (SUVmax) add functional information regarding cancer, including esophageal squamous cell carcinoma (ESCC). The aim of the present study was to determine the clinical significance and association of tumor progression using SUVmax derived from PET/CT images in patients with ESCC. In total, 101 patients with ESCC were assessed using FDG-PET/CT and the SUVmax was then compared with the clinical backgrounds and prognoses of the patients. Endoscopic ESCC biopsy specimens were obtained in order to analyze mRNA expression relative to tumor progression. The results showed that values for SUVmax were significantly higher in patients with tumor progression factors, particularly those with lymph node metastasis. Analysis of receiver operating characteristics curves revealed an optimum SUVmax cut-off value of 10.26 for node-positive disease. Patients with SUVmax â„10.26 had gene alterations with epithelial-mesenchymal transition (EMT) and significantly worse overall survival (P=0.0012). A higher SUVmax in patients with ESCC was associated with lymph node metastasis and a poorer prognosis. Thus, the SUVmax may reflect the potential of EMT in patients with ESCC.
IntroductionEsophageal cancer is an extremely lethal gastrointestinal neoplasm that leads to >300,000 mortalities worldwide annually (1). The reason for the poor prognosis is that >50% of patients already have unresectable or metastatic disease when they are diagnosed with esophageal cancer (2). A precise evaluation of the prognosis or overall survival (OS) of patients with esophageal cancer is essential for selecting appropriate treatment. Positron emission tomography/computed tomography (PET/CT) has become established in cancer imaging, and is useful for stratification during the primary staging of esophageal cancer by anatomical factors, such as tumor depth, invasion, lymph node metastasis and distant metastasis (3-10). However, 18 F-fluoro-2-deoxyglucose (FDG)-PET may be used to evaluate functional factors associated with tumor activity, which depends on glucose metabolism.It has been previously reported that the maximum standardized uptake value (SUVmax) in patients with certain types of cancer significantly correlates with survival, prognosis and recurrence (11,12). Although the clinical significance of SUVmax in esophageal cancer has been reported (13,14), the progression of esophageal cancer in specimens of esophageal squamous cell carcinoma (ESCC) using gene analysis has not yet been assessed. Therefore we investigated whether the