Metabolic tumor volume provides complementary prognostic information to EUS staging in esophageal and junctional cancer

• Published in: Diseases of the esophagus Vol. 30; no. 3; pp. 1 - 8
• Main Authors: Malik, Vinod, Johnston, Ciaran, O’Toole, Dermot, Lucey, Julie, O’Farrell, Naoimh, Claxton, Zieta, Reynolds, John V.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.03.2017
• Subjects: Adult; Aged; Aged, 80 and over; Endosonography - methods; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophagogastric Junction - diagnostic imaging; Esophagogastric Junction - pathology; Esophagoscopy - methods; Female; Fluorodeoxyglucose F18; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Staging; Positron Emission Tomography Computed Tomography - methods; Prognosis; Proportional Hazards Models; Prospective Studies; Radiopharmaceuticals; Regression Analysis; Statistics, Nonparametric; Tumor Burden; Young Adult; esophageal cancer; 18F-FDG PET-CT; endoscopic ultrasound; staging
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/dote.12505

SUMMARY To determine the correlation between 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) derived esophageal tumor parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV)] and endoscopic ultrasound (EUS) derived tumor parameters (T stage, N stage) and their prognostic implications. 150 consecutive patients with cancer of the esophagus or esophagogastric junction underwent staging PET-CT and staging EUS. PET-CT derived SUVmax and MTV of the primary tumor was recorded. EUS evaluated T and N stage. Relationships between parameters were investigated using the Mann-Whitney U tests, survival analysis performed using Kaplan-Meier and independent prognostic factors determined using Cox regression multivariate analysis. A significant difference in MTV was noted between EUS T1/T2 tumors (median 6.7 cm3) and EUS T3/T4 tumors (median 35.7 cm3; P < 0.0001). An MTV of <23.4 cm3 (P = 0.0001), SUVmax < 4.1 (P = 0014), EUS T stage (P < 0.0001), EUS N stage (P < 0.0001), and clinical stage (P < 0.0001) were all significantly associated with survival, with MTV <23.4 cm3 (P = 0.004), EUS T stage (P = 0.01), and EUS N stage (P = 0.01) significant in multivariate analysis. MTV, a volumetric parameter of PET-CT, has more prognostic importance than SUVmax and provides valuable prognostic information in esophageal and junctional cancer, along with EUS T and N stage. MTV provides complementary information to EUS and should be included in the staging of esophageal and junctional cancer.