Prognostic value of baseline (18)F-FDG PET/CT in patients with esophageal squamous cell carcinoma treated with definitive (chemo)radiotherapy

PURPOSE: To investigate the prognostic value of baseline (18)F-FDG PET/CT in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive (chemo)radiotherapy. METHODS: A total of 98 ESCC patients with cTNM stage T1-4, N1-3, M0 who received definitive (chemo)radiotherapy after (18)F-FDG PET/CT examination from December 2013 to December 2020 were retrospectively analyzed. Clinical factors included age, sex, histologic differentiation grade, tumor location, clinical stage, and treatment strategies. Parameters obtained by (18)F-FDG PET/CT included SUV(max) of primary tumor (SUV(Tumor)), metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUV(max) of lymph node (SUV(LN)), PET positive lymph nodes (PLNS) number, the shortest distance between the farthest PET positive lymph node and the primary tumor in three-dimensional space after the standardization of the patient BSA (SD(max(LN-T))). Univariate and multivariate analysis was conducted by Cox proportional hazard model to explore the significant factors affecting overall survival (OS) and progression-free survival (PFS) in ESCC patients. RESULTS: Univariate analysis showed that tumor location, SUV(Tumor), MTV, TLG, PLNS number, SD(max (LN-T)) were significant predictors of OS and tumor location, and clinical T stage, SUV(Tumor), MTV, TLG, SD(max (LN-T)) were significant predictors of PFS (all p < 0.1). Multivariate analysis showed that MTV and SD(max (LN-T)) were independent prognostic factors for OS (HR = 1.018, 95% CI 1.006–1.031; p = 0.005; HR = 6.988, 95% CI 2.119–23.042; p = 0.001) and PFS (HR = 1.019, 95% CI 1.005–1.034; p = 0.009; HR = 5.819, 95% CI 1.921–17.628; p = 0.002). Combined with independent prognostic factors MTV and SD(max (LN-T)), we can further stratify patient risk. CONCLUSIONS: Before treatment, (18)F-FDG PET/CT has important prognostic value for patients with ESCC treated with definitive (chemo)radiotherapy. The lower the value of MTV and SD(max (LN-T)), the better the prognosis of patients.