Prediction of Occult Lymph Node Metastasis by Metabolic Parameters in Patients with Clinically N0 Esophageal Squamous Cell Carcinoma

摘要

id="p-2">The aim of this study was to investigate the value of 18F-FDG parameters of the primary tumor in predicting occult lymph node metastasis in patients with clinically N0 esophageal squamous cell carcinoma. >Methods: The study comprised 143 consecutive patients (mean age ?± SD, 63.9 ?± 8.6 y; range, 31.8-81.2 y) from May 2003 to January 2010 who had clinically N0 esophageal squamous cell carcinoma based on preoperative imaging studies including chest CT, 18F-FDG PET/CT, and endoscopic ultrasound. We measured maximum standardized uptake value (SUV_max), mean SUV (SUV_mean), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of the primary tumor and analyzed the relationship between clinicopathologic variables including PET parameters and occult lymph node metastasis using a logistic regression model. >Results: Univariate analysis indicated that clinical T classification, SUV_max, SUV_mean, MTV, TLG, and longitudinal diameter of tumor were significant risk factors associated with occult lymph node metastasis. Optimal thresholds were cT2-4, SUV_max a‰￥ 4.8, SUV_mean a‰￥ 3.2, MTV a‰￥ 5.5 cm3, TLG a‰￥ 220, and diameter a‰￥ 3.8 cm. After multivariate analysis, the logistic regression model revealed that clinical T classification (hazard ratio [HR], 4.6; 95% confidence interval [CI], 1.7-12.4; P = 0.003) and SUV_max (HR, 3.5; 95% CI, 1.3-9.2; P = 0.012) were independent risk factors. The combination of SUV_max and clinical T classification (HR, 13.2; 95% CI, 5.4-31.9; P 0.001) was a significantly better powerful risk factor for occult lymph node metastasis than SUV_max or clinical T classification alone. Sensitivity, specificity, positive predictive value, and negative predictive value of the combination of clinical T classification and SUV_max were 73.0%, 81.5%, 60.0%, and 89.7%, respectively. >Conclusion: SUV_max, combined with clinical T classification, may be useful for predicting occult lymph node metastasis in patients with clinically N0 squamous cell carcinoma of the esophagus.