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Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT

OBJECTIVE: During neoadjuvant chemoradiotherapy for oesophageal cancer, or in the interval prior to surgery, some patients develop systemic metastasis. This study aimed to evaluate the diagnostic performance of (18)F-FDG PET/CT for the detection of interval metastasis and to identify predictors of i...

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Autores principales: Goense, Lucas, Ruurda, Jelle P., Carter, Brett W., Fang, Penny, Ho, Linus, Meijer, Gert J., van Hillegersberg, Richard, Hofstetter, Wayne L., Lin, Steven H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097755/
https://www.ncbi.nlm.nih.gov/pubmed/29663014
http://dx.doi.org/10.1007/s00259-018-4011-6
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author Goense, Lucas
Ruurda, Jelle P.
Carter, Brett W.
Fang, Penny
Ho, Linus
Meijer, Gert J.
van Hillegersberg, Richard
Hofstetter, Wayne L.
Lin, Steven H.
author_facet Goense, Lucas
Ruurda, Jelle P.
Carter, Brett W.
Fang, Penny
Ho, Linus
Meijer, Gert J.
van Hillegersberg, Richard
Hofstetter, Wayne L.
Lin, Steven H.
author_sort Goense, Lucas
collection PubMed
description OBJECTIVE: During neoadjuvant chemoradiotherapy for oesophageal cancer, or in the interval prior to surgery, some patients develop systemic metastasis. This study aimed to evaluate the diagnostic performance of (18)F-FDG PET/CT for the detection of interval metastasis and to identify predictors of interval metastases in a large cohort of oesophageal cancer patients. METHODS: In total, 783 consecutive patients with potentially resectable oesophageal cancer who underwent chemoradiotherapy and pre- and post-treatment (18)F-FDG PET/CT between 2006 and 2015 were analyzed from a prospectively maintained database. Diagnostic accuracy measures were calculated on a per-patient basis using histological verification or clinical follow-up as a reference standard. Multivariable logistic regression analysis was performed to determine pre-treatment predictors of interval metastasis. A prediction score was developed to predict the probability of interval metastasis. RESULTS: Of 783 patients that underwent (18)F-FDG PET/CT restaging, 65 (8.3%) were found to have interval metastasis and 44 (5.6%) were deemed to have false positive lesions. The resulting sensitivity and specificity was 74.7% (95% CI: 64.3–83.4%) and 93.7% (95% CI: 91.6–95.4%), respectively. Multivariable analysis revealed that tumor length, cN status, squamous cell tumor histology, and baseline SUV(max) were associated with interval metastasis. Based on these criteria, a prediction score was developed with an optimism adjusted C-index of 0.67 that demonstrated accurate calibration. CONCLUSIONS: (18)F-FDG PET/CT restaging detects distant interval metastases in 8.3% of patients after chemoradiotherapy for oesophageal cancer. The provided prediction score may stratify risk of developing interval metastasis, and could be used to prioritize additional restaging modalities for patients most likely to benefit.
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spelling pubmed-60977552018-08-24 Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT Goense, Lucas Ruurda, Jelle P. Carter, Brett W. Fang, Penny Ho, Linus Meijer, Gert J. van Hillegersberg, Richard Hofstetter, Wayne L. Lin, Steven H. Eur J Nucl Med Mol Imaging Original Article OBJECTIVE: During neoadjuvant chemoradiotherapy for oesophageal cancer, or in the interval prior to surgery, some patients develop systemic metastasis. This study aimed to evaluate the diagnostic performance of (18)F-FDG PET/CT for the detection of interval metastasis and to identify predictors of interval metastases in a large cohort of oesophageal cancer patients. METHODS: In total, 783 consecutive patients with potentially resectable oesophageal cancer who underwent chemoradiotherapy and pre- and post-treatment (18)F-FDG PET/CT between 2006 and 2015 were analyzed from a prospectively maintained database. Diagnostic accuracy measures were calculated on a per-patient basis using histological verification or clinical follow-up as a reference standard. Multivariable logistic regression analysis was performed to determine pre-treatment predictors of interval metastasis. A prediction score was developed to predict the probability of interval metastasis. RESULTS: Of 783 patients that underwent (18)F-FDG PET/CT restaging, 65 (8.3%) were found to have interval metastasis and 44 (5.6%) were deemed to have false positive lesions. The resulting sensitivity and specificity was 74.7% (95% CI: 64.3–83.4%) and 93.7% (95% CI: 91.6–95.4%), respectively. Multivariable analysis revealed that tumor length, cN status, squamous cell tumor histology, and baseline SUV(max) were associated with interval metastasis. Based on these criteria, a prediction score was developed with an optimism adjusted C-index of 0.67 that demonstrated accurate calibration. CONCLUSIONS: (18)F-FDG PET/CT restaging detects distant interval metastases in 8.3% of patients after chemoradiotherapy for oesophageal cancer. The provided prediction score may stratify risk of developing interval metastasis, and could be used to prioritize additional restaging modalities for patients most likely to benefit. Springer Berlin Heidelberg 2018-04-16 2018 /pmc/articles/PMC6097755/ /pubmed/29663014 http://dx.doi.org/10.1007/s00259-018-4011-6 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Goense, Lucas
Ruurda, Jelle P.
Carter, Brett W.
Fang, Penny
Ho, Linus
Meijer, Gert J.
van Hillegersberg, Richard
Hofstetter, Wayne L.
Lin, Steven H.
Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT
title Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT
title_full Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT
title_fullStr Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT
title_full_unstemmed Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT
title_short Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)F-FDG PET/CT
title_sort prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using (18)f-fdg pet/ct
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097755/
https://www.ncbi.nlm.nih.gov/pubmed/29663014
http://dx.doi.org/10.1007/s00259-018-4011-6
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