Positron emission tomography complete metabolic response as a favorable prognostic predictor in esophageal cancer following neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil

doi:10.5306/wjco.v12.i4.249

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World Journal of Clinical Oncology

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Retrospective Cohort Study

World J Clin Oncol. Apr 24, 2021; 12(4): 249-261
Published online Apr 24, 2021. doi: 10.5306/wjco.v12.i4.249

Positron emission tomography complete metabolic response as a favorable prognostic predictor in esophageal cancer following neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil

Kosuke Suzuki, Tsuyoshi Etoh, Tomotaka Shibata, Kohei Nishiki, Shoichi Fumoto, Yoshitake Ueda, Hidefumi Shiroshita, Norio Shiraishi, Masafumi Inomata

Kosuke Suzuki, Tsuyoshi Etoh, Tomotaka Shibata, Yoshitake Ueda, Hidefumi Shiroshita, Norio Shiraishi, Masafumi Inomata, Department of Gastroenterological and Pediatric Surgery, Oita University, Yufu 879-5593, Oita, Japan

Kohei Nishiki, Shoichi Fumoto, Department of Surgery, Oita Nakamura Hospital, Oita 870-0022, Japan

Author contributions: Suzuki K, Etoh T, Shibata T and Inomata M contributed to conception and design; Suzuki K, Etoh T, Nishiki K, Fumoto S, Ueda Y, Shiroshita H and Shiraishi N contributed to literature search, acquisition, analysis and interpretation; Suzuki K and Etoh T are responsible for drafting and revising the manuscript; All authors affirm final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Institutional review board statement: This study was approved by the institutional Ethical Review Board of Oita University Faculty of Medicine (Approval No. 1602).

Informed consent statement: Informed consent of this study is shown in HP of Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine (http://www.surgery1.med.oita-u.ac.jp).

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: Please contact to Suzuki K (kosuzuki@oita-u.ac.jp) to get the data of this study.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Corresponding author: Kosuke Suzuki, PhD, Assistant Professor, Department of Gastroenterological and Pediatric Surgery, Oita University, 1-1 Idaigaoka, Hasama, Yufu 879-5593, Oita, Japan. kosuzuki@oita-u.ac.jp

Received: September 21, 2020
Peer-review started: September 21, 2020
First decision: November 16, 2020
Revised: November 25, 2020
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 24, 2021
Processing time: 211 Days and 6.9 Hours

ARTICLE HIGHLIGHTS

Research background

Recent studies have shown that ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) can determine the degree of metabolic activity in tumor cells and can improve tumor staging for patients with esophageal cancer. Furthermore, several studies have shown that FDG-PET/computed tomography (CT) (FDG-PET/CT) is useful for diagnosing metastatic lymph nodes and distant metastasis and for detecting the recurrence of esophageal cancer after surgery. However, the value of FDG-PET/CT to predict survival in patients with esophageal cancer is controversial.

Research motivation

Accurate assessment of cancer remnants after neoadjuvant chemotherapy (NAC) in esophageal cancer may lead to a watch-and-see treatment strategy to avoid surgery.

Research objectives

We aimed to evaluate the value of PET complete metabolic response in esophageal cancer following NAC as a prognostic predictor.

Research methods

We reviewed data from 70 consecutive patients with squamous cell esophageal cancer who were preoperatively evaluated with FDG-PET/CT before and after NAC with docetaxel, cisplatin and 5-fluorouracil between June 2013 and December 2017 at Oita University. Those who received definitive radiotherapy/chemotherapy after NAC (n = 11) and underwent esophagectomy in another hospital (n = 1) were excluded. Thus, 58 patients received esophagectomy after NAC and were enrolled in this retrospective cohort study.

Research results

Five-year relapse-free survival and overall survival (OS) in the PET complete metabolic response group were significantly more favorable than those in the non-PET complete metabolic response group (38.6 mo vs 20.8 mo, P = 0.021, 42.8 mo vs 25.1 mo, P = 0.011, respectively). The univariate analysis of OS showed pathologic T, N, M, stage, complete response and CT-PET negative T and N to be statistically significant. Then, the multivariate analysis subsequently selected CT-PET negative N (hazard ratio: 8.268; 95% confidence interval 1.74-63.60; P < 0.01) as the only independent covariate for OS.

Research conclusions

The multivariate analysis subsequently selected CT-PET negative N (hazard ratio: 8.268; 95% confidence interval: 1.74-63.60; P < 0.01) as the only independent covariate for OS.

Research perspectives

In limited patients with PET-negative lymph nodes after NAC, a watch-and-see strategy may be one possible option to avoid unnecessary esophagectomy in the future.