18F-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 18F-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-SUVmax), post-SUVmax and %SUVmax 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-SUVmax-N (P=0.0001) and %SUVmax-T (P=0.0031) were significant prognostic factors by univariate analysis. The multivariate analysis identified post-SUVmax-N as the only significant prognostic predictor (P=0.0254). Patients with a post-SUVmax-N of <3.0 exhibited significantly fewer pathological metastatic nodes and better disease-free survival compared with patients with a post-SUVmax-N >3.0. Therefore, post-SUVmax-N may be a useful prognostic predictor in patients with advanced esophageal cancer who are treated with NAC followed by surgery.