Investigation of the diagnostic and prognostic impact of posttreatment fluorine-18 fluorodeoxyglucose PET/computed tomography on M0 esophageal cancer

Chang-Shen Tseng; Bee-Song Chang; Shu-Hang Ng; Shu-Hsin Liu; Jason Chia-Hsun Hsieh; Sheng-Chieh Chan

doi:10.1097/MNM.0000000000002004

Investigation of the diagnostic and prognostic impact of posttreatment fluorine-18 fluorodeoxyglucose PET/computed tomography on M0 esophageal cancer

Nucl Med Commun. 2025 Jun 30. doi: 10.1097/MNM.0000000000002004. Online ahead of print.

Authors

Chang-Shen Tseng¹, Bee-Song Chang², Shu-Hang Ng³, Shu-Hsin Liu¹, Jason Chia-Hsun Hsieh^{4

5

6}, Sheng-Chieh Chan^{1

7}

Affiliations

¹ Department of Nuclear Medicine.
² Department of Cardiothoracic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien.
³ Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan.
⁴ Division of Hematology/Oncology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City.
⁵ Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan.
⁶ College of Medicine, Chang Gung University, Taoyuan.
⁷ School of Medicine, Tzu Chi University, Hualien, Taiwan.

PMID: 40583585
DOI: 10.1097/MNM.0000000000002004

Abstract

Objective: Fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) is an essential examination to stage patients with esophageal cancer; however, the role of posttreatment [18F]FDG PET/CT in patients with esophageal cancer has not been well explored. We aimed to investigate the prognostic and diagnostic value of posttreatment PET/CT in patients with esophageal cancer after their definitive treatment.

Methods: This retrospective study enrolled 208 patients with biopsy-proven esophageal cancer. Posttreatment PET/CT scans were performed greater than or equal to 3 months after the completion of definitive therapy, with a total of 539 scans included in this study. The outcome measures were the diagnostic capacity of PET/CT and patient survival. Survival analysis was conducted using Kaplan-Meier plots, accompanied by the Mantel-Cox log-rank test and Cox regression.

Results: The sensitivity, specificity, and accuracy of posttreatment PET/CT for recurrent tumors were 93.67, 92.65, and 92.95%, respectively. PET/CT identified recurrent tumors in 24.58% of scans obtained for tumor surveillance and ruled out recurrence in 40.30% of scans obtained with prior clinical suspicion. Negative PET/CT had a predictive value of 80% for nonrecurrence before the next planned scan, while positive PET results were significantly associated with poorer patient survival following the scan (P < 0.0001). In the multivariate Cox regression model, the PET/CT result was identified as an independent prognostic factor [P < 0.0001, hazard ratio (HR)=3.818] with a higher hazard ratio compared with the tumor stage (P = 0.01, HR=1.633) or treatment modality (P = 0.0002, HR = 2.035).

Conclusion: We illustrate the favorable performance of posttreatment [18F]FDG PET/CT in both detecting tumor recurrence and evaluating the prognosis of patients with M0 esophageal cancer. These findings imply the potential of [18F]FDG PET/CT as a follow-up imaging modality in these patients.

Keywords: esophageal cancer; follow-up; surveillance.