Prognostic value of 18F-FDG PET/CT metabolic parameters and sarcopenia in esophageal squamous carcinoma
Objective To evaluate the value of pretreatment18F-fluorodeoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)metabolic parameters and sarcopenia in risk stratification of patients with esophageal squamous carcinoma.Methods A total of 91 patients with esophageal squamous carcinoma were enrolled,which included 69 males and 22 females,aged 43-85 years old with mean age of 67 years old.According to TNM staging,there were 37 cases(40.66％)of stage I-Ⅱ and 54 cases(59.34％)of stage Ⅲ-Ⅳ.Body mass index(BMI)＜18.5 kg/m2 in 19 cases,18.5-24.9 kg/m2 in 55 cases,25.0-29.9 kg/m2 in 14 cases,≥30 kg/m2 in 3 cases.Sarcopenia was determined by measuring the skeletal muscle index of the third lumbar spine on PET/CT.The metabolic parameters of 18F-FDG PET/CT included the maximum standardized uptake value(SUVmax),mean standardized uptake value(SUVmean),metabolic tumor volume(MTV),and total lesion glycolysis(TLG)of primary tumor.The Cox regression models were utilized to identify variables associated with survival.Re-sults Among the 91 patients,42(46.2％)were diagnosed with sarcopenia.After median follow-up of 18 months(1-69 months),41.76％(38/91)patients showed disease progression,and 30.77％(28/91)patients died,the median progression-free survival(PFS)and overall survival(OS)were 15 months and 18 months,respectively.Tumor clinical stage,BMI,lymphatic vascular invasion(LVI),skeletal muscle index(SMI)and primary tumor MTV were important indicators for predicting PFS and OS,which were used to construct nomogram and showed excellent predictive ability in evaluating the survival and prognosis of patients with esophageal cancer.In multivariate analysis,MTV[PFS:P=0.025,hazard ratio(HR)=3.388,95％confidence interval(CI)=1.168-9.831;OS:P=0.033,HR=4.882,95％CI=1.135-20.986],BMI(PFS:P=0.001,HR=2.296,95％CI=1.423-3.702;OS:P=0.021,HR=1.952,95％CI=1.104-3.451)and sarcopenia(PFS:P=0.001,HR=3.640,95％CI=1.692-7.830;OS:P=0.002,HR=4.237,95％CI=1.715-10.465)were independent prognostic factors for PFS and OS.Compared with non-sarcopenia patients,sarcopenia patients showed poorer PFS and OS.Similarly,PFS and OS were poor in patients with MTV＞5.33 and low BMI.Conclusion It is demonstrated that baseline 18F-FDG PET/CT metabolic parameters MTV,BMI and sarcopenia are independent prognostic factors in patients with esophageal squamous carcinoma;high level MTV,low BMI and sar-copenia are associated with poorer survival rate.
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