The higher the decrease in the standardized uptake value of positron emission tomography after chemoradiation, the better the survival of patients with gastroesophageal adenocarcinoma

Abstract

BACKGROUND:Postchemoradiation percentage decrease in standardized uptake value (SUV) of positron emission tomography (PET) from baseline correlates with overall survival (OS) and pathologic response. Analyses of dichotomized data are commonly reported. The authors analyzed percentage SUV decrease as both dichotomized and continuous variables.METHODS:The authors assessed 151 consecutive patients with gastroesophageal adenocarcinoma who had chemoradiation and surgery. Baseline and postchemoradiation PET/computed tomography imaging was performed. The log‐rank test and Cox proportional hazards models were used to associate percentage SUV changes and OS, and logistic regression models were used to detect the association between percentage SUV changes and pathologic response.RESULTS:A >52% SUV decrease (dichotomized analysis) was associated with a longer OS (log‐rank test, P = .023). The univariate Cox proportional hazards model indicated that greater percentage SUV decrease (as a continuous variable) was associated with a lower risk of death (hazard ratio [HR], 0.99; P = .01). Pathologic response (≤50% residual cancer) was associated with longer OS (P = .003). Patients with chemoradiation resistance (>50% residual cancer) tended to have a higher risk of death than those with chemoradiation sensitivity (0‐50% residual cancer; HR, 2.12; P = .099). In the multivariate model, the percentage SUV decrease (as a continuous variable) was the only prognosticator of OS (P = .01). The percentage SUV decrease was nonsignificantly associated with pathologic complete response (univariate odds ratio [OR], 1.01; P = .06 and multivariate OR, 1.03; P = .07).CONCLUSIONS:The greater the decline in SUV after chemoradiation, the longer is the OS of gastroesophageal adenocarcinoma patients. The percentage SUV decrease as a continuous variable is a better prognosticator of OS than its dichotomized assessments. Cancer 2009. © 2009 American Cancer Society.

Prognostic significance of SUV on PET/CT in patients with localised oesophagogastric junction cancer receiving neoadjuvant chemotherapy/chemoradiation: a systematic review and meta-analysis

“…24 of these studies were excluded because the log HR and its variance of the oesophagogastric junction carcinoma from the total patients with oesophageal or gastric carcinoma could not be calculated (n512) [15][16][17][18][19][20][21][22][23][24][25][26], an author published two reports on the same population (n51) [27,28], and irrelevant references including the studies without surgery such as Murthy et al (n511) [29]. Finally, a total of 10 studies were determined to be evaluable for the actual analysis [27,[30][31][32][33][34][35][36][37]. The principal characteristics of the 10 studies evaluable for the meta-analysis are described in Table 1.…”

“…The scan time for 18 F-FDG-PET was as follows: prior to therapy (PET1), exactly 2 weeks after initiation of neoadjuvant therapy (PET2) and pre-operatively (PET3). Six studies dealt with the prognostic value of changes in glucose utilisation, measured by 18 F-PDG-PET from PET1 to PET2 or PET3 for overall survival (OS) [30,31,33,35,37,38]. Four studies dealt with the prognostic value of changes in maximum SUV (SUV max ) measured on 18 F-PDG-PET for DFS at the same time [30,34,35,37].…”

“…Moreover, the metaanalyses were performed for the studies that dealt only with changes in SUV max from PET1 to PET2 for predictions of OS and DFS. Three studies dealt with the prognostic value of SUV max measured on 18 F-PDG-PET at PET1 [27,32,35] for OS, and three studies did it at PET2/PET3 for OS [31,35,36]. The meta-analyses that dealt only with SUV for DFS prediction at PET1 [35] and PET2/PET3 [35,36] were excluded owing to too few articles.…”

“…However, none of the studies achieved definite statistical significance. Three studies used the median as the SUV max threshold, and the best cut-off value was used in two studies in addition to analysing SUV max as a continuous variable in one study [31].…”

“…Smith et al [34] Decreased SUV max (from PET1 to PET2) Weight Best cut-off .50% Rizk et al [27] Initial SUV max (at PET1) Weight Previous report 4.5 Javeri et al [32] Initial SUV max (at PET1) Weight Median 10.1 Javeri et al [31] FDG uptake at day (12¡2 weeks, at PET3) Weight Continuous variableDecreased SUV max (12¡2 weeks after initiation of therapy, from PET1 to PET3) Weight Previous report .52%…”