Prognostic Value of F-fluorodeoxyglucose Uptake in the Bone Marrow on Pretreatment Positron Emission Tomography/computed Tomography in Patients with Esophageal Cancer Who Underwent Esophagectomy

Overview

Journal Esophagus

Publisher Springer

Specialties Gastroenterology
Oncology

Date 2023 May 2

PMID 37129700

Authors

Naoya Yoshida

Kojiro Eto

Tomo Horinouchi

Shinya Shiraishi

Kosuke Kanemitsu

Takashi Ofuchi

Takuya Tajiri

Yuki Adachi

Taichi Horino

Atsushi Morito

Chishou Mitsuura

Yuto Maeda

Yoshihiro Hara

Chihiro Matsumoto

Hideo Baba

Affiliations

Soon will be listed here.

Abstract

Background: Increased F-fluorodeoxyglucose (FDG) uptake in the bone marrow (BM) on positron emission tomography/computed tomography (PET/CT) clinically reflects increased BM metabolism owing to systemic inflammation, bacterial infection, anemia, and cytokine-producing tumors. The association between FDG uptake in the BM and prognosis after esophagectomy for esophageal cancer has not been investigated.

Methods: This study included 651 patients who underwent PET/CT before any treatment and McKeown esophagectomy for esophageal cancer between June 2007 and August 2021. The pretreatment degree of FDG uptake in the BM was evaluated using a visual assessment criterion. Patients were divided into low- and high-FDG uptake groups. We retrospectively investigated whether the degree of FDG uptake in the BM was associated with clinicopathological and surgical backgrounds, blood parameters, and prognosis.

Results: High FDG uptake in the BM was significantly associated with elevated white blood cell and neutrophil counts, increased C-reactive protein levels, decreased hemoglobin, serum albumin, and total cholesterol levels. High FDG uptake in the BM was an independent predictor of worse overall survival in clinical stages 0-II esophageal cancer (hazard ratio, 2.27; 95% confidence interval, 1.097-4.695; P = 0.027). Worse overall survival was also associated with advanced age, low American Society of Anesthesiologists physical status, an advanced clinical stage, and high intraoperative blood loss.

Conclusion: Increased FDG uptake in the BM on pretreatment PET/CT may be a surrogate indicator of various clinically disadvantageous backgrounds and may act as a predictor of poor prognosis after esophageal cancer surgery.

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