A Systematic Review of the Predictive Value of (18)FDG-PET in Esophageal and Esophagogastric Junction Cancer After Neoadjuvant Chemoradiation on the Survival Outcome Stratification

Schollaert, Pascaline;Crott, Ralph;Claude, Bertrand;D'Hondt, Lionel;Krug, Bruno;et.al.
(2014) Journal of Gastrointestinal Surgery — Vol. 18, n° 5, p. 894-905 (2014)

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Abstract
PURPOSE: We studied the predictive value of [18 F]fluorodeoxyglucose-positron emission tomography (18FDG-PET) for assessing disease-free (DFS) and overall survival (OS) in esophageal and esophagogastric junction cancer. MATERIALS AND METHODS: A literature search (PUBMED/MEDLINE, EMBASE, Cochrane) was performed to identify full papers with 18FDG-PET and survival data, using indexing terms and free text words. Studies with >10 patients with locally advanced esophageal cancer, presenting sequential or at least one post-adjuvant treatment 18FDG-PET data and Kaplan-Meier survival curves with >6 months median follow-up period were included. We performed a meta-analysis for DFS and OS using the hazard ratio (HRs) as outcome measure. Sources of heterogeneity study were also explored. RESULTS: We identified 26 eligible studies including a total of 1,544 patients (average age 62 years, 82 % males). The TNM distribution was as follows: stage I 7 %, II 24 %, III 53 % and IV 15 %. The pooled HRs for complete metabolic response versus no response were 0.51 for OS (95 % CI, 0.4-0.64; P < 0.00001) and 0.47 for DFS (95 % CI, 0.38-0.57; P < 0.00001), respectively. No statistical heterogeneity was present. To explore sources of clinical heterogeneity, we also realised subgroup and regression analyses. Taken into account the moderate correlation between OS and DFS (ρ = 0.54), we used joint bivariate random regression model. These analyses did not show a statistically significant impact of study characteristics and PET modalities on the pooled outcome estimates. CONCLUSION: Despite methodological and clinical heterogeneity, metabolic response on 18FDG-PET is a significant predictor of long-term survival data.
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Schollaert, P., Crott, R., Claude, B., D’Hondt, L., Vander Borght, T., & Krug, B. (2014). A Systematic Review of the Predictive Value of (18)FDG-PET in Esophageal and Esophagogastric Junction Cancer After Neoadjuvant Chemoradiation on the Survival Outcome Stratification. Journal of Gastrointestinal Surgery, 18(5), 894-905. https://doi.org/10.1007/s11605-014-2488-2 (Original work published 2014)