The prognostic value of total lesion glycolysis via 18F-fluorodeoxyglucose PET-CT in surgically treated esophageal squamous cell carcinoma

Abstract

OBJECTIVE: In addition to staging, the identification of prognostic factors is important for predicting survival in patients with esophageal cancer after esophagectomy. The present study was performed to document the prognostic role of total lesion glycolysis (TLG) in postoperative patients. METHODS: We retrospectively reviewed the records of 50 patients with esophageal squamous cell carcinoma who underwent surgical resection and complete lymph node dissection after positron emission tomography-computed tomography (PET-CT). A volume of interest was drawn on the primary lesion and suspected metastatic lymph nodes, and the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), TLG of the primary lesion (TLGp), and whole-body TLG (TLGwb) were measured using an SUV cutoff of 2.5. RESULTS: The study population included 50 patients with a mean age of 63.14 +/- 8.18 years: 12 (24%) were reported as stage I, 13 (26%) as stage II, and 25 (50%) as stage III. The median follow-up period was 20.46 months, and recurrences occurred in 17 patients. The mean SUVmax, MTV, TLGp, and TLGwb were 11.11 +/- 6.40, 20.47 +/- 22.88, 122.54 +/- 180.98, and 129.37 +/- 193.66, respectively. On the multivariate analysis, TLGp was a risk factor for disease-free survival (DFS) [hazard ratio (HR) = 1.002, p = 0.026], and TLGwb was a risk factor for DFS (HR = 1.002, p = 0.021) and overall survival (OS) (HR = 1.002, p = 0.044). The 3-year OS rates were 66.1% in patients with low TLGwb (</= 41.45) and 33.3% in those with high TLGwb (>41.45: p = 0.004). The concordance index of the TLGwb was 0.752 (95% CI 0.659-0.845). CONCLUSION: TLGwb is a significant prognostic factor for OS and DFS in patients with surgically treated esophageal squamous cell carcinoma.