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

Is CT Radiomics Superior to Morphological Evaluation for pN0 Characterization? A Pilot Study in Colon Cancer

“…The idea of a ratio between the two entities, which is able to discriminate between healthy homogeneous tissue and malignant heterogeneous tissue, relies on similar concept obtained in nuclear medicine. Example are provided by Cho J et al [27], with higher performances of the SUV ratio between LNs and PLs, and by Chen P J and colleagues [28] that demonstrated the better performances of a SUV ratio between LNs and PLs in esophageal cancer in terms of survival.…”

Could tumour volume and major and minor axis based on CTA statistical anatomy improve the pre‐operative T‐stage in oesophageal cancer?

“…The more advanced the stage, the greater the critical value, indicating that the higher the T‐stage of the tumour, the greater the increase in volume. Chen et al 35 used cut‐off values to help physicians diagnose the EC's radiotherapy efficacy. They analysed patients with non‐metastatic and unrespectable ESCC who underwent pre‐operative FDG PET/CT and were treated with chemoradiotherapy, and used ROC analysis to determine the optimal cut‐off value for the primary tumour (NTR).…”

Prognostic value of node-to-primary tumor maximum standardized uptake value ratio in T1-4N1-3M0 non-small cell lung cancer patients treated with concurrent chemo-radiotherapy

“…In their report, multivariable analysis showed that NTR was an independent prognostic factor for distant metastasis-free survival (hazard ratio 2.20, 95% CI 1.20–4.03, P = 0.011). Similarly, it has been demonstrated that NTR was an independent factor for predicting prognosis in unresectable esophageal cancer [ 10 ], endometrioid endometrial carcinoma [ 11 ], and invasive ductal breast cancer [ 33 ]. Kaira et al [ 34 ] found that higher ratio of SUVmax of the metastatic tumor to the primary tumor (M/P ratio) portended lower response to initial chemotherapy and poorer survival (PFS and OS) in stage IIIB and IV NSCLC patients [ 22 ].…”

“…In addition to these traditional PET parameters, several recent studies investigated the role of a ratio parameter called the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) [9][10][11][12]. Several studies had found that the patients with relatively high NTR are significantly associated with poor outcomes, suggesting that the NTR has different behaviors between tumors with higher and lower metastatic potential [10,12]. However, few studies investigated the prognostic value of NTR in NSCLC patients treated with concurrent chemo-radiotherapy.…”