Value Of ¹⁸F-FDG PET/CT Combined With CT Perfusion In Predicting The Treatment Response And Prognosis Of ESCC

Part Ⅰ The value of 18F-FDG PET/CT parameters in predicting the treatment response and overall survival of esophageal squamous cell carcinomaPurposeTo explore the value of pretreatment PET-related parameters,including maximum standardized uptake value(SUVmax),mean standardized uptake value(SUVmean),metabolic tumor volume(MTV),total lesion glycolysis(TLG)and PET tumor length(PTL)in predicting tumor response and overall survival(OS)of in patients with esophageal squamous cell carcinoma(ESCC)treated with definitive chemoratitheapy(dCRT).Materials and methodsRetrospective analysis was performed on 147 patients.All of them received 18F-FDG PET/CT scan before treatment.Four weeks after the completion of treatment,the patients were evaluated for tumor response to dCRT according to RECIST 1.1.Patients rated as complete response(CR)or partial response(PR)were considered effective,while patients rated as stable disease(SD)or progressive disease(PD)were considered ineffective.SPSS 22.0 version was used for statistical analysis.Two-sample t test or Mann-Whitney U test was used to compare the differences of SUVmax,SUVmean,MTV,and TLG between the treatment effective group and the ineffective group.Receiver operating characteristic(ROC)curves and area under the curves(AUCs)were used to compare the performance of different parameters in predicting the response or OS.Kaplan-Meier method and log-rank tests to analyze differences in survival curves.Univariate and multivariate Cox analysis were used to identify prognostic factors that were valuable for the prediction of OS.Results(1)Baseline SUVmax(p=0.001),SUVmean(p<0.001),MTV(p=0.002),TLG(p=0.001)and PTL(p=0.030)in stage Ⅲ patients were significantly higher than those of stage Ⅳ patients.(2)Baseline MTV,TLG,and PTL can distinguish between the treatment-effective group and the ineffective group.The MTV(p=0.020),TLG(p=0.027)and PTL(p=0.022)of the effective group are significantly lower than those of ineffective group.However,there was no significant difference in SUVmax and SUVmean between the two groups(p>0.05).ROC analysis showed that the performance of each parameter was ranked as MTV>PTL>TLG,and the AUC was 0.617,0.615,and 0.611,respectively.SUVmax and SUVmean have no ability to predict the response(p>0.05).(3)In terms of OS prediction,the ranking of performance was MTV>TLG>PTL,AUC was 0.678,0.663,0.659,respectively.SUVmax and SUV mean have no prognostic value(p>0.05).Kaplan-Meier analysis showed that the low MTV group,low TLG group,and low PTL had significantly improved OS compared with the high MTV group,high TLG group,and high PTL(p values were 0.002,0.043,and 0.001,respectively).There was no statistically significant difference in survival curves between SUVmax or SUVmean groups(p>0.05).Univariate analysis showed that gender(p=0.032),N stage(p=0.005),first-line response(p=0.023),MTV(p<0.001),TLG(p=0.002),PTL(p=0.022)were significant prognostic factors.Multivariate analysis revealed that N stage(HR:3.030;95%CI:1.528-6.007;p=0.002)and MTV(HR:1.028;95%CI:1.004-1.052;p=0.023)were independent prognostic factors for OS.ConclusionsIn terms of predicting the tumor response in ESCC patients,MTV,TLG,and PTL all showed predictive efficacy,and MTV had the strongest predictive power.In terms of OS,MTV has been proved to be an independent predictor and the best prognostic parameter.Part Ⅱ The value of CT perfusion parameters in predicting the treatment response and overall survival of esophageal squamous cell carcinomaPurposeTo explore the predictive value of CT perfusion imaging parameters,including blood flow(BF),blood volume(BV),peak enhancement image(PEI)and time to peak(TTP),on the tumor response to CRT and the OS in patients with ESCC.Materials and methodsA retrospective analysis was performed on 42 patients who received dCRT.Response evaluation and follow-up were the same as the first part.SPSS 22.0 was used for statistical analysis.The difference of BF,BV,TTP and PEI in different TNM groups or the effective and ineffective groups was compared by the two-sample t-test or mann-whitney U test.ROC curves and AUCs were used to compare the performance of different parameters in predicting the response or OS.Kaplan-Meier method and log-rank tests to analyze differences in survival curves.Univariate and multivariate Cox regression analysis were used to identify prognostic factors that were valuable for the prediction of OS.Results(1)Patients with stage Ⅲ have significantly higher baseline BV(p=0.020)than that of stage Ⅱ patients.However,BF,PEI,TTP in stage Ⅱ or Ⅲ patients had no significant difference(p>0.05).In terms of N stage,the BV value of the positive metastatic lymph node group was significantly higher than that of the non-metastatic lymph node group(p=0.028).(2)The BF value of the effective group was higher than that of the ineffective group(p=0.001),while the TTP value was significantly lower than that of the ineffective group(p=0.012).There was no significant difference in PEI and BV values between the two groups(p>0.05).ROC analysis showed that BF and TTP had the value of predicting response,with AUC of 0.815(p=0.001)and 0.702(p=0.031).The predictive value of BV(AUC=0.632;p=0.160)and PEI(AUC=0.677;p=0.061)was significantly lower than that of BF and TTP.(3)In terms of OS prediction,the performance ranking is BF>PEI,and the AUC is 0.731(p=0.007)and 0.678(p=0.036),respectively.Kaplan-meier curve showed that the median OS of the group with high BF,high PEI and high BV was significantly prolonged than that of the group with low BF,low PEI and low BV(p values<0.001,0.002 and 0.002,respectively).Univariate analysis showed that age(p=0.038),T stage(p=0.004),treatment response(p<0.001),BF(p=0.001),BV(p=0.003)and PEI(p=0.002)were significant prognostic factors.Multivariate analysis showed that only age(HR:3.232;95%CI:1.374 7.598;p=0.007),T staging(HR:3.377;95%CI:1.4028.136;p=0.007)and BF(HR:0.970;95%CI:0.943 0.997;p=0.032)were independent predictors of OS.ConclusionsPerfusion parameters have great potential in predicting the pre-treatment TNM stage,treatment response and OS of ESCC.For staging,especially for N staging,BV is the most valuable.For the tumor response and OS prediction,BF is the best predictive parameter.Part Ⅲ The value of 18F-FDG PET/CT combined with CT perfusion in predicting the treatment response and prognosis of ESCCPurposeTo investigate the correlation between perfusion parameters and metabolic parameters in ESCC,and to evaluate the value of each metabolism-perfusion phenotype,especially the high metabolism-low perfusion phenotype in predicting the response and prognosis of patients with ESCC.Materials and methodsProspectively enrolled 30 patients,the enrollment criteria were:1)ESCC confirmed by pathology;2)No previous anti-tumor treatment;3)age 18-75 years old,ECOG PS 0-2 score,clinical TNM stage Ⅱ-Ⅲ;4)plan to receive dCRT;exclusion criteria:1)history of other malignant tumors;2)hypersensitivity to contrast agents.The response evaluation and follow-up are the same as the first part.SPSS 22.0 version was used for statistical analysis.Spearman’s rank correlation analysis of the correlation between perfusion parameters and metabolic parameters.Two-sample t test or Mann-Whitney U test to compare the difference between metabolic parameters and perfusion parameters between the treatment effective group and the ineffective group.Kaplan-Meier method and log rank test were used to perform survival anylysis.Univariate and multivariate Cox proportional hazard models determine valuable prognostic factors.Results(1)There was no significant’ correlation between metabolic parameters(SUVmax,SUVmean,MTV,TLG)and perfusion parameters(BF,BV,TTP,PEI)(p>0.05);(2)Construct different metabolism-perfusion groups,including MTV-BF group(Group Ⅰ,Ⅱ,Ⅲ)and SUVmax-BF group(Group A,B,C).Relationship between different groups and tumor response:The ORR of Group Ⅰ(low MTV-high BF phenotype)was 100%,the ORR of Group Ⅱ(high MTV-high BF and low BF-low MTV phenotype)was 57.1%,the ORR of Group Ⅲ(high MTV-low BF phenotype)was only 12.5%,there was a significant difference between ORRs(p=0.002).Similarly,the ORRs of Group A(low SUVmax-high BF phenotype),Group B(high SUVmax-high BF and low SUVmax-low BF phenotype),Group C(high SUVmax-low BF phenotype)gradually decreased(87.5%,64.3%and 12.5%,respectively)and the difference was statistically significant(p=0.008).(3)Relationship between metabolism-perfusion groups and survival:Kaplan-Meier curve analysis showed that for OS,the median OS of Group Ⅰ,Group Ⅱ,and GroupⅢ patients was successively shortened,with a statistically significant difference(p<0.001).The median PFS of Group Ⅰ,Group Ⅱ,and Group Ⅲ patients also gradually shortened,and the PFS curves were significantly different(p=0.002).Also,Kaplan-Meier analysis showed that from Group A to Group B to Group C,the median OS of patients gradually decreased,with a significant difference(p=0.001),In terms of PFS,the median PFS of Group A,Group B,and Group C also shortened in turn,with a statistical difference(p=0.041).Univariate analysis showed that the MTV-BF group and the SUVmax-BF group were both prognostic factors with OS(p<0.001 and p=0.002)and PFS(p=0.001 and p=0.017),and multivariate analysis showed that the MTV-BF group(HR:6.015;95%CI:2.007-18.024;p=0.001),SUVmax-BF group(HR:2.666;95%CI:1.133-6.270;p=0.025)were both independent prognostic factors of OS,while only the MTV-BF group(HR:2.888;95%CI:1.172-7.116;p=0.021)was an independent predictor of PFS.ConclusionsThere was no significant correlation between perfusion and metabolic parameters,therefore,the combination of the two can provide complementary functional information for ESCC patients.The metabolism-perfusion phenotype grouping based on MTV-BF or SUVmax-BF may better predict the treatment response and prognosis for ESCC.