The impact of intratumoral metabolic heterogeneity on postoperative recurrence and survival in resectable esophageal squamous cell carcinoma

// Xinzhe Dong 1, 2 , Xiaorong Sun 3 , Xianguang Zhao 1 , Wanqi Zhu 1 , Lu Sun 4 , Yong Huang 3 , Wenwu Li 3 , Honglin Wan 5 , Ligang Xing 1, 2 , Jinming Yu 1, 2 1 Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China 2 Key Laboratory of Radiation Oncology of Shandong Province, Shandong Academy of Medical Sciences, Jinan, Shandong, China 3 Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China 4 Jinan University, Jinan, Shandong, China 5 College of Physics and Electronic Science, Shandong Normal University, Jinan, Shandong, China Correspondence to: Ligang Xing, email: sdcancerhospital@163.com Keywords: positron emission tomography, FDG, esophageal carcinoma, intratumoral heterogeneity, prognosis Received: July 18, 2016      Accepted: January 10, 2017      Published: January 19, 2017 ABSTRACT Objective: To evaluate the impact of intratumoral metabolic heterogeneity measured by 18F-FDG PET imaging on postoperative recurrence and survival for patients with esophageal squamous cell carcinoma (ESCC). Results: AUC-CSH, metabolic tumor volume and pN-stage were significant prognostic factors for RFS. Additionally, tumor recurrence of the low AUC-CSH group (≤ 0.478) was 3 times higher than high group ( P = 0.015). The median OS of patients with advanced AJCC stage or low AUC-CSH was also significantly shorter than that of patients with stage I & II or high AUC-CSH ( P = 0.021, 0.009). Multivariate analysis identified the AUC-CSH to be the only significant risk factor for postoperative recurrence and overall survival in whole-group and stage III patients. Materials and Methods: 116 ESCC patients who underwent staging 18F-FDG PET-CT scan and surgical resection were reviewed. The metabolic parameters were assessed as follows: maximum standardized uptake value (SUV max ), metabolic tumor volume, and the area under the curve of the cumulative SUV-volume histogram (AUC-CSH), which is known to reflect the intratumoral metabolic heterogeneity. Regression analyses were used to identify clinicopathological and imaging variables associated with relapse-free survival (RFS) and overall survival (OS). Conclusions: Intratumoral metabolic heterogeneity characterized by AUC-CSH can predict postoperative recurrence and survival in patients with resectable ESCC.