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PROGNOSTIC SIGNIFICANCE OF 18-FDG PET/CT ENHANCED STAGING IN PATIENTS UNDERGOING SURGERY FOR ESOPHAGEAL CANCER
Neil Patel*1, Jeniffer Wheat1, Paul Blake1, Chris Brown1, Arfon G. Powell1, David Chan1, Kieran G. Foley2, Guy Blackshaw1, Stuart A. Roberts2, Wyn G. Lewis1
1General Surgery, University Hospital Wales, Cardiff, Wales, United Kingdom; 2Radiology, Univeristy Hospital Wales, Cardiff, United Kingdom
Background: CT-PET has become an integral part of the staging pathway for potentially curable esophageal
cancer (OC) in order to identify occult distant metastases unseen by conventional radiological modalities. The aim of this study was to analyse the effect of CT-PET inception on overall survival and assess patterns of recurrence after esophagectomy.
Methods: Consecutive 424 patients undergoing esophagectomy performed for cancer [median age 62 (24-80) yr, 337 male, 360 ACA, 64 SCC, 254 neoadjuvant therapy] were studied. One hundred and sixty-nine patients underwent CT-PET enhanced staging protocols and the primary outcome measure was survival based on intention to treat.
Results: Overall 5-year survival pre CT-PET was 37%, compared with 49% post CT-PET (Chi2 4.991, df 1, p<0.025). On multivariable analysis, pT stage (HR 1.497 [95% CI 1.344-1.667], p< 0.001) and CT-PET (HR 0.509 [95% CI 0.352-0.735], p<0.001) were independently associated with duration of survival. Recurrent cancer was observed in 119 patients pre CT-PET (46.7%); 24.4% local, 58.8% distant, 16.8% both, compared with 33 (19.5%) recurrences post CT-PET (19.5%, Chi2 32.554, df 1, p<0.0001); 27.3% local; 57.6% distant; 15.1% both.
Conclusion: CT-PET enhanced staging independently improves survival in patients undergoing esophagectomy for esophageal cancer.
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