The clinical significance of lymph node (LN) status determined by preoperative 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) has not been investigated in patients with locally advanced esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (NCRT) followed by surgery (trimodal therapy).
We reviewed 132 consecutive patients with ESCC who were preoperatively evaluated using FDG-PET before and after NCRT to analyze associations among LN status according to PET findings, pathological LN metastasis and the prognosis of ESCC after trimodal therapy.
PET-positive LN both before and after NCRT comprised significant predictive markers of pathological LN metastasis (sensitivity, specificity and accuracy: 84.5%; 40.5%; 59.8% [p = 0.002] before, and 27.6%, 87.8% and 61.4% [p = 0.02] after NCRT, respectively). The numbers of LN evaluated using PET before and after NCRT and of pathological metastatic LN were significantly associated. Univariate and multivariable analyses selected LN status determined by PET before NCRT as a significant independent predictor of both recurrence-free (LN negative vs. positive: hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.02 – 3.23; p = 0.045) and overall survival (HR, 2.62; 95% CI, 1.29 – 5.30, p = 0.01).
The status of LN determined by preoperative FDG-PET is significantly associated with pathological LN status and the prognosis of ESCC with trimodal therapy. Thus, FDG-PET is a useful diagnostic tool with which to preoperatively predict pathological LN metastasis and survival among patients with ESCC.
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