18 F-fluorodeoxyglucose positron emission tomography/computed tomography for the prediction of survival in patients with advanced esophageal cancer who have undergone neoadjuvant chemotherapy.

Neoadjuvant chemotherapy (NAC) is a promising treatment strategy for advanced esophageal cancer. However, measures of NAC response assessment and prognostic prediction have not yet been established. The aim of this study was to evaluate the usefulness of combined ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT). A total of 77 patients with stage IB-IV esophageal cancer who were treated with NAC followed by curative resection were retrospectively analyzed. PET/CT was performed before and after NAC and 56 patients were clinical responders. The pretreatment maximal standardized uptake value (pre-SUV _max ), post-SUV _max and %SUV _max were 11.3±5.8, 5.1±4.8 and 49.0±35.1%, respectively, for the main tumors (T) and 4.3±2.8, 2.5±1.9 and 67.0±39.6%, respectively, for the metastatic nodes (N). Among the preoperatively available factors, clinical response (P=0.018), post-SUV _max -N (P=0.0001) and %SUV _max -T (P=0.0031) were significant prognostic factors by univariate analysis. The multivariate analysis identified post-SUV _max -N as the only significant prognostic predictor (P=0.0254). Patients with a post-SUV _max -N of <3.0 exhibited significantly fewer pathological metastatic nodes and better disease-free survival compared with patients with a post-SUV _max -N >3.0. Therefore, post-SUV _max -N may be a useful prognostic predictor in patients with advanced esophageal cancer who are treated with NAC followed by surgery.