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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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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

Table 1 Patient characteristics

	PET-CMR, n = 22	Non-PET-CMR, n = 36	P value
Age, mean	65.9 (48.0-76.0)	65.0 (47.0-80.0)	0.82
Male/Female	20/2	33/3	0.41
Comorbidity	15	28
Location
Ce	1	4	0.58
Ut	4	3
Mt	10	17
Lt	7	12
Before NAC
cStage
cT
T1	2	0	0.044
T2	6	3
T3	13	32
T4	1	1
cN
N0	5	9	0.27
N1	12	14
N2	4	13
N3	1	0
cM
M0	17	28	0.96
M1	5	8
cStage
I	3	4	0.94
II	4	5
III	10	19
IVA	5	8
IVB	0	0
Primary, SUV_max mean	16.4 ± 6.5	15.7 ± 6.5	0.98
LN+	14 (63.6%)	21 (58.3%)	0.69
After NAC
CT-Stage
T
T1	9	2	0.0058
T2	12	26
T3	1	6
T4	0	2
N
N0	21	21	0.0081
N1	1	8
N2	0	7
N3	0	0
M
M0	22	36	-
M1	0	0
Stage
0	5	0	0.0017
I	4	1
II	12	23
III	1	10
IVA	0	2
IVB	0	0
Down stage	15	17	0.119

Ce: Cervical esophagus; CT: Computed tomography; LN: Lymph node; Lt: Lower thoracic esophagus; Mt: Middle thoracic esophagus; NAC: Neoadjuvant chemotherapy; PET-CMR: Positron emission tomography-complete metabolic response; SUV_max: Maximal standardized uptake value; Ut: Upper thoracic esophagus

Table 2 Surgical outcomes

	PET-CMR, n = 22	Non-PET-CMR, n = 36	P value
Esophagectomy procedures
Subtotal	20	32	0.31
Cervical	1	0
Pharyngeal laryngeal	1	4
LN dissection
Cervical	1	2	0.89
2 fields	5	10
3 fields	16	24
Harvested LN¹	72 ± 7	73 ± 5	0.91
Blood loss in mL¹	559 ± 219	836 ± 540	0.026
OP time in min¹	527 ± 105	580 ± 121	0.092
Curability
R0	22	29	0.027
R1	0	7
Intraoperative complication
Bronchus injury	1	1	0.72
Postoperative complication
All	14	22	0.85
Anastomotic leakage²	1	1	0.72
Anastomotic stenosis²	2	3	0.92
Recurrent nerve palsy²	7	12	0.91
Respiratory²	3	8	0.42
Others²	2	3	0.92
Surgical mortality	0	0	-

¹mean ± SD.

²Clavien-Dindo Classification ≥ 3.

LN: Lymph node; OP: Operation; PET-CMR: Positron emission tomography-complete metabolic response.

Table 3 Pathological findings

	PET-CMR, n = 22	Non-PET-CMR, n = 36	P value
T
T0	9	5	< 0.0001
T1	11	4
T2	1	9
T3	1	12
T4	0	6
N
N0	13	14	0.052
N1	7	7
N2	2	8
N3	0	7
M
M0	20	32	0.81
M1	2	4
Stage
0	9	3	0.033
I	3	8
II	8	8
III	0	10
IVA	2	4
IVB	0	3
Ly+	4	22	0.001
v+	1	15	0.002
Pathological grade
0	0 (0%)	3 (8%)	0.029
1a	4 (18%)	14 (39%)
1b	3 (14%)	6 (17%)
2	6 (27%)	10 (28%)
3	9 (41%)	3 (8%)

Ly: Lymphatic invasion; PET-CMR: Positron emission tomography-complete metabolic response; v: Venous invasion.

Table 4 Accuracy of positron emission tomography complete metabolic response

	TP	FP	TN	FN	Accuracy	Sensitivity	Specificity
T factor	30	4	10	14	69.0%	68.2%	71.4%
N factor	13	2	25	18	65.5%	41.9%	92.6%
T and N	33	3	13	9	72.4%	71.7%	75.0%

FN: False negative; FP: False positive; TN: True negative; TP: True positive.

Table 5 Sites of recurrence

	PET-CMR, n = 5	Non-PET-CMR, n = 17	P value
Local	0	4	0.66
Distant	5	16
Extraregional LN	3	6
Liver	0	5
Bone	1	4
Lung	1	3
Pleura	0	2

LN: Lymph node; PET-CMR: Positron emission tomography-complete metabolic response.

Table 6 Univariable and multivariable analyses of prognostic factors in esophageal cancer

	Relapse-free survival
	Univariate			Multivariate
	RR	95%CI	P value	RR	95%CI	P value
Age	0.982	0.935-1.033	0.468
Male/Female	2.211	0.638-5.920	0.1885
Location, MtLtAe/CeUt	1.230	0.406-3.090	0.689
Tumor grade, other/por	2.612	1.050-6.026	0.040	1.412	0.498-3.785	0.503
pT, 0▪1▪2/3▪4	4.554	1.983-10.770	0.0004	1.195	0.433-3.432	0.734
pN, 0/1▪2▪3	5.287	2.062-16.320	0.0003	3.172	1.074-10.710	0.036
pM, 0/1	2.543	0.726-6.977	0.131
pStage, 0▪1▪2/3▪4	8.655	3.652-22.060	< 0.0001	2.449	0.356-16.800	0.357
pCR (primary tumor), CR (+)/nonCR (-)	5.199	1.501-32.770	0.0063	1.878	0.337-15.060	0.487
CT-PET-T, (-)/(+)	2.561	1.059-7.120	0.0036
CT-PET-N, (-)/(+)	10.810	4.251-28.160	< 0.0001	22.570	4.694-177.800	< 0.0001
CT-PET-CMR, (-)/(+)	2.523	1.034-7.063	0.041

Ae: Abdominal esophagus; Ce: Cervical esophagus; CI: Confidence interval; CR: Complete response; CT-PET-N: Computed tomography-positron emission tomography negative N; CT-PET-T: Computed tomography-positron emission tomography negative T; Lt: Lower thoracic esophagus; Mt: Middle thoracic esophagus; pCR: Pathological complete response; PET-CMR: Positron emission tomography-complete metabolic response; por: Poorly differentiated carcinoma; RR: Relative risk; Ut: Upper thoracic esophagus.

Table 7 Univariable and multivariable analyses of prognostic factors in esophageal cancer

	Overall survival
	Univariate			Multivariate
	RR	95%CI	P value	RR	95%CI	P value
Age	1.036	0.972-1.112	0.285
Male/Female	1.302	0.204-4.683	0.736
Location, MtLtAe/CeUt	1.057	0.242-3.291	0.931
Tumor grade, other/por	1.603	0.499-4.466	0.403
0▪1▪2/3▪4	8.167	2.912-25.340	< 0.0001	1.644	0.430-8.039	0.486
pN, 0/1▪2▪3	5.653	1.803-24.800	0.0021	0.924	0.045-7.556	0.946
pM, 0/1	5.043	1.354-15.690	0.019	1.518	0.302-6.353	0.588
pStage, 0▪1▪2/3▪4	15.52	5.062-58.400	< 0.0001	5.760	0.415-160.800	0.197
pCR (primary tumor), CR (+)/nonCR (-)	3.202	0.887-20.470	0.0793
CT-PET-T, (-)/(+)	3.227	1.106-11.680	0.0313	1.450	0.307-6.866	0.630
CT-PET-N, (-)/(+)	25.270	6.361-168.100	< 0.0001	8.268	1.748-63.630	0.006
CT-PET-CMR, (-)/(+)	2.927	0.996-10.660	0.0510

Citation: Suzuki K, Etoh T, Shibata T, Nishiki K, Fumoto S, Ueda Y, Shiroshita H, Shiraishi N, Inomata M. Positron emission tomography complete metabolic response as a favorable prognostic predictor in esophageal cancer following neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil. World J Clin Oncol 2021; 12(4): 249-261
URL: https://www.wjgnet.com/2218-4333/full/v12/i4/249.htm
DOI: https://dx.doi.org/10.5306/wjco.v12.i4.249