Serial imaging using [18F]Fluorodeoxyglucose positron emission tomography and histopathologic assessment in predicting survival in a population of surgically resectable distal oesophageal and gastric adenocarcinoma following neoadjuvant therapy

Abstract

Background and objectivesWe retrospectively evaluated the value of PET/CT in predicting survival and histopathological tumour-response in patients with distal oesophageal and gastric adenocarcinoma following neoadjuvant treatment.MethodsTwenty-one patients with resectable distal oesophageal adenocarcinoma and 14 with gastric adenocarcinoma between January 2002 and December 2011, who had undergone serial PET before and after neoadjuvant therapy followed by surgery, were enrolled. Maximum standard uptake value (SUVmax) and metabolic tumour volume were measured and correlated with tumour regression grade and survival.ResultsHistopathological tumour response (PR) is a stronger predictor of overall and disease-free survival compared to metabolic response. ∆%SUVmax ≥70% was the only PET metric that predicted PR (82.4% sensitivity, 61.5% specificity, p = 0.047). Histopathological non-responders had a higher risk of death (HR 8.461, p = 0.001) and recurrence (HR 6.385, p = 0.002) and similarly in metabolic non-responders for death (HR 2.956, p = 0.063) and recurrence (HR 3.614, p = 0.028). Ordinalised ∆%SUVmax showed a predictive trend for OS and DFS, but failed to achieve statistical significance.ConclusionsPR was a stronger predictor of survival than metabolic response. ∆%SUVmax ≥70% was the best biomarker on PET that predicted PR and survival in oesophageal and gastric adenocarcinoma. Ordinalisation of ∆%SUVmax was not helpful in predicting primary outcomes.

Peripheral venous blood neutrophil-to-lymphocyte ratio predicts survival in patients with advanced gastric cancer treated with neoadjuvant chemotherapy

“…Gastric resection with D2 lymph node dissection is the mainstay of treatment in advanced gastric carcinoma. Many randomized trials have indicated that adjuvant chemoradiotherapy has been a part of the combined modality therapy of advanced gastric cancer 5–7. Therefore, it is of significance to explore actively the potential prognostic factor in gastric cancer.…”

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

“…basierende endoskopische Responsekriterien (komplette Tumorregression oder < 50 % bzw. < 75 % residualer intraluminaler Tumor) mit der Prognose von Patienten mit Magenkarzinom korrelieren[578,579,591,592].Daten zum Stellenwert einer funktionellen Bildgebung wie PET (-CT)[584,586,[593][594][595][596][597][598][599] und Perfusionsbildgebung mit CT[600,601] und kontrastverstärktem Ultraschall[602,603] sind bisher präliminär und kontrovers.HintergrundPrognostisch relevante Faktoren des Adenokarzinoms des Magens sind die Tumorlokalisation, die lokale Tiefeninfiltration und der Lymphknotenbefall. Zur Beurteilung des Nodalstatus gehören die Präparation aller Lymphknoten und die Bestimmung der Zahl befallener Lymphknoten im Verhältnis zur Zahl der untersuchten Lymphknoten.…”