Intratumoral Metabolic Heterogeneity and Other Quantitative FDG PET/CT Parameters for Prognosis Prediction in Esophageal Cancer


PURPOSE: To evaluate the impact of intratumoral metabolic heterogeneity and other quantitative FDG PET/CT parameters for predicting patient outcomes in esophageal cancer. METHODS AND MATERIALS: This IRB and HIPPA compliant retrospective study included a total of 71 patients with biopsy proven adenocarcinoma or squamous cell carcinoma of the esophagus who had a FDG PET/CT for initial staging. Automated gradient-based segmentation method was used to assess the primary tumor standardized uptake value maximum and peak (SUV max and SUV peak), metabolic tumor volume (MTV) and metabolic intratumoral heterogeneity index, calculated as the area under cumulative SUV-volume histograms (AUC-CSH), with lower AUC-CSH indexes corresponding to higher degrees of tumor heterogeneity. Patient's demographics and tumor staging were also collected. Median follow up time was 28.2±30.3 months. Overall survival (OS) and progression free survival (PFS) were calculated using univariate cox regression with the adjustment of age, gender, staging, treatment and histological grade. All pet measurements were normalized and the hazard ratios change was equivalent to one standard deviation. RESULTS: The patients' mean age was 64±10.3 years and there were 6 patients with stage I, 11 with stage II, 31 with stage III, 21 with stage IV disease, and 2 with unknown staging. Median survival was 16.1 months. Forty-six patients died and 15 were alive as of the end of the study (for 10 patients no recent information on survival was available). Eighteen patients had recurrence as of the end of the study. Higher MTV was significantly associated with reduced PFS for every standard deviation increase (HR=0.193, 95% CI=0.052-0.711, p=0.0134). Higher AUC-CSH (lower tumor heterogeneity, homogeneous tumor) was significantly associated with increased PFS for every standard deviation increase in the area under the curve (HR=10.779, 95% CI=1.306-88.957, p=0.0272). CONCLUSION: There was a significant association of MTV and tumor heterogeneity with progression free survival for patients with esophageal cancer. CLINICAL RELEVANCE: FDG PET/CT quantitative parameters, particularly intramural metabolic heterogeneity, can provide prognostic information on initial staging scan, potentially leading to a more personalized approach for patient's treatment.

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The 58th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 21, 2020, 3-6 p.m., D1.600)

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Gopal, A., Xi, Y., Subramaniam, R., & Pinho, D. F. (2020, January 21). Intratumoral metabolic heterogeneity and other quantitative FDG PET/CT parameters for prognosis prediction in esophageal cancer. Poster session presented at the 58th Annual Medical Students Research Forum, Dallas, TX. Retrieved from

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