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We aimed to investigate the prognostic value of the relative maximum standardized uptake value (SUV) of metastatic lymph node (LN) compared with that of primary tumor (SUV LN / SUV Tumor ) based on a pretreatment [ 18 F]-FDG PET/CT scan in patients with clinically node-positive esophageal squamous cell carcinoma (cN+ ESCC) treated with definitive chemoradiotherapy (dCRT). We retrospectively evaluated cN+ ESCC patients who underwent a PET/CT scan before dCRT. Time-dependent receiver operating characteristics analysis was performed to identify the optimal cutoff value for SUV LN / SUV Tumor . Prognostic influences of SUV LN / SUV Tumor on distant metastasis-free survival (DMFS) and overall survival (OS) were evaluated using the Kaplan-Meier method and log-rank test for univariate analysis and Cox's proportional hazards regression model for multivariate analysis. We identified 112 patients with newly diagnosed cN+ ESCC. After a median follow-up of 32.0 months, 50 (44.6%) patients had distant failure and 84 (75.0%) patients died. Patients with high SUV LN / SUV Tumor (≥ 0.39) experienced worse outcomes than low SUV LN / SUV Tumor (&lt; 0.39) (two-year DMFS: 26% vs. 70%, p &lt; 0.001; two-year OS: 21% vs. 48%, p = 0.001). Multivariate analysis showed that SUV LN / SUV Tumor was an independent prognostic factor for both DMFS (adjusted HR 2.24, 95% CI 1.34-3.75, p = 0.002) and OS (adjusted HR 1.61, 95% CI 1.03-2.53, p = 0.037). Pretreatment of SUV LN / SUV Tumor is a simple and useful marker for prognosticating DMFS and OS in cN+ ESCC patients treated with dCRT, which may help in tailoring treatment and designing future clinical trials.

cancers

Prognostic Value of Lymph Node-To-Primary Tumor Standardized Uptake Value Ratio in Esophageal Squamous Cell Carcinoma Treated with Definitive Chemoradiotherapy