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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2019

01-06-2019 | Metastasis | Thoracic Oncology

Clinical Significance of 18F-Fluorodeoxyglucose-Positron Emission Tomography-Positive Lymph Nodes to Outcomes of Trimodal Therapy for Esophageal Squamous Cell Carcinoma

Authors: Yoichi Hamai, MD, PhD, Jun Hihara, MD, PhD, Manabu Emi, MD, PhD, Yuta Ibuki, MD, Yuji Murakami, MD, PhD, Ikuno Nishibuchi, MD, PhD, Yasushi Nagata, MD, PhD, Yoshiro Aoki, MD, PhD, Takaoki Furukawa, MD, PhD, Morihito Okada, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2019

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Abstract

Background

The clinical significance of lymph node (LN) status determined by preoperative 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) has not been investigated in patients with locally advanced esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (NCRT) followed by surgery (trimodal therapy).

Methods

This study reviewed 132 consecutive patients with ESCC who had been preoperatively evaluated using FDG-PET before and after NCRT to analyze associations among LN status according to PET findings, pathologic LN metastasis, and prognosis of ESCC after trimodal therapy.

Results

Lymph nodes that were PET-positive both before and after NCRT comprised significant predictive markers of pathologic LN metastasis in station-by-station analyses (sensitivity, specificity, and accuracy respectively 41.7%, 95.0%, and 92.7% before, and 12.0%, 99.4%, and 95.6% after NCRT; both p < 0.0001). The numbers of LNs evaluated using PET before and after NCRT were significantly associated with those of pathologic metastatic LNs. Uni- and multivariable analyses selected LN status determined by PET before NCRT as a significant independent predictor of both recurrence-free [LN-negative vs LN-positive: hazard ratio (HR) 1.90; 95% confidence interval (CI) 1.02–3.23; p = 0.045] and overall survival (HR 2.62; 95% CI 1.29–5.30; p = 0.01).

Conclusions

The status of LN determined by preoperative FDG-PET is significantly associated with pathologic LN status and the prognosis of ESCC with trimodal therapy. Thus, FDG-PET is a useful diagnostic tool for preoperative prediction of pathologic LN metastasis and survival among patients with ESCC.
Appendix
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Literature
1.
Sjoquist KM, Burmeister BH, Smithers BM, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12:681–92.CrossRefPubMed
2.
van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.CrossRefPubMed
3.
Berger AC, Farma J, Scott WJ, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol. 2005;23:4330–7.CrossRefPubMed
4.
Miyata H, Yamasaki M, Takiguchi S, Nakajima K, Fujiwara Y, Mori M, Doki Y. Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation. Oncol Rep. 2010;23:1331–7.CrossRefPubMed
5.
Akutsu Y, Shuto K, Kono T, et al. The number of pathologic lymph nodes involved is still a significant prognostic factor even after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma. J Surg Oncol. 2012;105:756–60.CrossRefPubMed
6.
Hamai Y, Hihara J, Emi M, et al. Evaluation of prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy followed by surgery. World J Surg. 2018;42:1496–505.CrossRefPubMed
7.
Schmidt T, Lordick F, Herrmann K, Ott K. Value of functional imaging by PET in esophageal cancer. J Natl Compr Cancer Netw. 2015;13:239–47.CrossRef
8.
Kato H, Nakajima M. The efficacy of FDG-PET for the management of esophageal cancer: review article. Ann Thorac Cardiovasc Surg. 2012;18:412–9.CrossRefPubMed
9.
Goense L, van Rossum PS, Reitsma JB, et al. Diagnostic performance of 18F-FDG PET and PET/CT for the detection of recurrent esophageal cancer after treatment with curative intent: a systematic review and meta-analysis. J Nucl Med. 2015;56:995–1002.CrossRefPubMed
10.
Stiekema J, Vermeulen D, Vegt E, et al. Detecting interval metastases and response assessment using 18F-FDG PET/CT after neoadjuvant chemoradiotherapy for esophageal cancer. Clin Nucl Med. 2014;39:862–7.CrossRefPubMed
11.
Hamai Y, Hihara J, Emi M, Furukawa T, Yamakita I, Kurokawa T, Okada M. Ability of fluorine-18fluorodeoxyglucose positron emission tomography to predict outcomes of neoadjuvant chemoradiotherapy followed by surgical treatment for esophageal squamous cell carcinoma. Ann Thorac Surg. 2016;102:1132–9.CrossRefPubMed
12.
Cong L, Wang S, Gao T, Hu L. The predictive value of 18F-FDG PET for pathological response of primary tumor in patients with esophageal cancer during or after neoadjuvant chemoradiotherapy: a meta-analysis. Jpn J Clin Oncol. 2016;46:1118–26.PubMed
13.
Sobin L, Gospodarowicz M, Wittekind C, editors. International Union Against Cancer (UICC): TNM Classification of Malignant Tumours. 7th ed. New York: Wiley; 2009.
14.
Hamai Y, Hihara J, Emi M, Murakami Y, Kenjo M, Nagata Y, Okada M. Results of neoadjuvant chemoradiotherapy with docetaxel and 5-fluorouracil followed by esophagectomy to treat locally advanced esophageal cancer. Ann Thorac Surg. 2015;99:1887–93.CrossRefPubMed
15.
Emi M, Hihara J, Hamai Y, Aoki Y, Okada M, Kenjo M, Murakami Y. Neoadjuvant chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil for esophageal cancer. Cancer Chemother Pharmacol. 2012;69:1499–505.CrossRefPubMed
16.
Hamai Y, Hihara J, Taomoto J, Yamakita I, Ibuki Y, Okada M. Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer. Dis Esophagus. 2015;28:358–64.CrossRefPubMed
17.
Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th edition: part II and III. Esophagus. 2017;14:37–65.CrossRef
18.
Yasuda T, Yano M, Miyata H, Yamasaki M, Takiguchi S, Fujiwara Y, Doki Y. Prognostic significance of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)-positive lymph nodes following neoadjuvant chemotherapy and surgery for resectable thoracic esophageal squamous cell carcinoma. Ann Surg Oncol. 2015;22:2599–607.CrossRefPubMed
19.
Yasuda T, Higuchi I, Yano M, et al. The impact of 18F-fluorodeoxyglucose positron emission tomography positive lymph nodes on postoperative recurrence and survival in resectable thoracic esophageal squamous cell carcinoma. Ann Surg Oncol. 2012;19:652–60.CrossRefPubMed
20.
Gillies RS, Middleton MR, Han C, Marshall RE, Maynard ND, Bradley KM, Gleeson FV. Role of positron emission tomography-computed tomography in predicting survival after neoadjuvant chemotherapy and surgery for oesophageal adenocarcinoma. Br J Surg. 2012;99:239–45.CrossRefPubMed
21.
Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th edition: part I. Esophagus. 2017;14:1–36.CrossRef
22.
Miyata H, Yamasaki M, Takahashi T, et al. Relevance of [18F]fluorodeoxyglucose positron emission tomography-positive lymph nodes after neoadjuvant chemotherapy for squamous cell oesophageal cancer. Br J Surg. 2013;100:1490–7.CrossRefPubMed
23.
Kim SJ, Pak K, Chang S. Determination of regional lymph node status using 18F-FDG PET/CT parameters in oesophageal cancer patients: comparison of SUV, volumetric parameters and intratumoral heterogeneity. Br J Radiol. 2016;89:20150673.CrossRefPubMed
24.
Kim SJ, Kim IJ, Kim K. Predictive value of metabolic tumor volume measured by 18F-FDG PET for regional lymph node status in patients with esophageal cancer. Clin Nucl Med. 2012;37:442–6.CrossRefPubMed
25.
Ela Bella AJ, Zhang YR, Fan W, et al. Maximum standardized uptake value on PET/CT in preoperative assessment of lymph node metastasis from thoracic esophageal squamous cell carcinoma. Chin J Cancer. 2014;33:211–7.PubMed
26.
Hsu PK, Lin KH, Wang SJ, Huang CS, Wu YC, Hsu WH. Preoperative positron emission tomography/computed tomography predicts advanced lymph node metastasis in esophageal squamous cell carcinoma patients. World J Surg. 2011;35:1321–6.CrossRefPubMed
27.
Karashima R, Watanabe M, Imamura Y, et al. Advantages of FDG-PET/CT over CT alone in the preoperative assessment of lymph node metastasis in patients with esophageal cancer. Surg Today. 2015;45:471–7.CrossRefPubMed
28.
Miyata H, Yamasaki M, Makino T, et al. Impact of number of [18F]fluorodeoxyglucose-PET-positive lymph nodes on survival of patients receiving neoadjuvant chemotherapy and surgery for oesophageal cancer. Br J Surg. 2016;103:97–104.CrossRefPubMed
29.
Elliott JA, O’Farrell NJ, King S, et al. Value of CT-PET after neoadjuvant chemoradiation in the prediction of histological tumour regression, nodal status, and survival in oesophageal adenocarcinoma. Br J Surg. 2014;101:1702–11.CrossRefPubMed
30.
Song SY, Kim JH, Ryu JS, et al. FDG-PET in the prediction of pathologic response after neoadjuvant chemoradiotherapy in locally advanced, resectable esophageal cancer. Int J Radiat Oncol Biol Phys. 2005;63:1053–9.CrossRefPubMed
31.
Yen TJ, Chung CS, Wu YW, et al. Comparative study between endoscopic ultrasonography and positron emission tomography-computed tomography in staging patients with esophageal squamous cell carcinoma. Dis Esophagus. 2012;25:40–7.CrossRefPubMed
32.
Kato H, Kimura H, Nakajima M, et al. The additional value of integrated PET/CT over PET in initial lymph node staging of esophageal cancer. Oncol Rep. 2008;20:857–62.PubMed
33.
Yoon SK, Jung JI, Park MJ, et al. Multidetector CT assessment of lymph node size for nodal staging in patients with potentially operable squamous esophageal cancer and the 18F-FDG positron emission tomography CT correlation. J Korean Soc Radiol. 2010;62:235–43.CrossRef
34.
Okada M, Murakami T, Kumano S, Kuwabara M, Shimono T, Hosono M, Shiozaki H. Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early-stage esophageal cancer. Ann Nucl Med. 2009;23:73–80.CrossRefPubMed
35.
Shi W, Wang W, Wang J, Cheng H, Huo X. Meta-analysis of 18FDG PET-CT for nodal staging in patients with esophageal cancer. Surg Oncol. 2013;22:112–6.CrossRefPubMed
36.
Yamada H, Hosokawa M, Itoh K, et al. Diagnostic value of F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma. Surg Today. 2014;44:1258–65.CrossRefPubMed
37.
Park SY, Kim DJ, Jung HS, Yun MJ, Lee JW, Park CK. Relationship between the size of metastatic lymph nodes and positron emission tomographic/computer tomographic findings in patients with esophageal squamous cell carcinoma. World J Surg. 2015;39:2948–54.CrossRefPubMed
38.
Hong D, Lunagomez S, Kim EE, et al. Value of baseline positron emission tomography for predicting overall survival in patient with nonmetastatic esophageal or gastroesophageal junction carcinoma. Cancer. 2005;104:1620–6.CrossRefPubMed
39.
Deng HY, Wang WP, Wang YC, Hu WP, Ni PZ, Lin YD, Chen LQ. Neoadjuvant chemoradiotherapy or chemotherapy? A comprehensive systematic review and meta-analysis of the options for neoadjuvant therapy for treating oesophageal cancer. Eur J Cardiothorac Surg. 2017;51:421–31.PubMed
Metadata
Title
Clinical Significance of 18F-Fluorodeoxyglucose-Positron Emission Tomography-Positive Lymph Nodes to Outcomes of Trimodal Therapy for Esophageal Squamous Cell Carcinoma
Authors
Yoichi Hamai, MD, PhD
Jun Hihara, MD, PhD
Manabu Emi, MD, PhD
Yuta Ibuki, MD
Yuji Murakami, MD, PhD
Ikuno Nishibuchi, MD, PhD
Yasushi Nagata, MD, PhD
Yoshiro Aoki, MD, PhD
Takaoki Furukawa, MD, PhD
Morihito Okada, MD, PhD
Publication date
01-06-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07158-5

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