Total Lesion Glycolysis Using ¹⁸F-FDG PET/CT as a Prognostic Factor for Locally Advanced Esophageal Cancer

Abstract

Standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) have been considered prognostic factors for survival in many cancers. However, their prognostic value for radiotherapy-treated squamous esophageal cancer has not been evaluated. In this study, SUV, MTV, and TLG were measured to predict their prognostic role in overall survival (OS) in 38 esophageal cancer patients who had undergone 18F-FDG PET/CT before radiotherapy. TLG demonstrated higher sensitivity and specificity for predicting OS than MTV and SUV; and a better OS was observed in patients with low TLG compared to those with high TLG in locally advanced disease (OS, 46.9 months; 95% confidence interval [CI], 33.50-60.26 vs. 25.3 months; 95% CI, 8.37-42.28; P=0.003). Multivariate analyses in these patients determined that TLG and the use of combination chemotherapy were the independent prognostic factors for OS (hazard ratio [HR], 7.12; 95% CI, 2.038-24.857; P=0.002 and HR, 6.76; 95% CI, 2.149-21.248; P=0.001, respectively). These results suggest that TLG is an independent prognostic factor for OS and a better predictor of survival than MTV and SUV in patients with locally advanced esophageal cancer treated with radiotherapy.

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

“…In contrast to the current study, larger prior studies in patients with HNSCC and EC have correlated worse outcomes with higher baseline SUVmax [14,[23][24][25]. Similarly, larger prior studies suggest that higher TLG values correlated with worse oncologic outcomes [24][25][26][27]. When analyzed by disease site in this study, no baseline PET characteristics correlated with outcomes.…”

Standardized Uptake Values Derived from18F-FDG PET May Predict Lung Cancer Microvessel Density and Expression of KI 67, VEGF, and HIF-1αbut Not Expression of Cyclin D1, PCNA, EGFR, PD L1, and p53

“…In fact, pretreatment SUV is commonly used as a relative measure of 18 FDG uptake and is considered a prognostic factor for risk stratification in different malignancies. However, as suggested previously, it does not reflect the heterogeneity of a tumor [ 76 ]. Therefore, to overcome this drawback of SUV, other PET parameters, such as metabolic tumor volume and total lesion glycolysis that reflect metabolic volume and activity, have been proposed as quantitative indexes of tumor metabolism [ 76 , 77 ].…”

Capsaicin inhibits glycolysis in esophageal squamous cell carcinoma by regulating hexokinase‑2 expression

“…Further investigations revealed that PTEN was involved in the capsaicin-mediated inhibition of tumor glycolysis in ESCC cells. Clinical studies have demonstrated that the level of glycolysis in tumor tissue, which can be detected with 18 F-FDG-PET/computerized tomography technology, is a useful prognostic factor for patients with ESCC (22,23). The conversion of glucose to glucose-6-phosphate, an irreversible step in glycolysis, is mediated by HK-2.…”