18FDG-PET-CT identifies histopathological non-responders after neoadjuvant chemotherapy in locally advanced gastric and cardia cancer: cohort study.
- Schneider PM Center for Visceral, Thoracic and specialized Tumor Surgery, Hirslanden Medical Center, Witellikerstrasse 40, CH-8032, Zurich, Switzerland. paul@professor-schneider.ch.
- Eshmuminov D Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
- Rordorf T Department of Oncology, University Hospital Zurich, Zurich, Switzerland.
- Vetter D Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
- Veit-Haibach P Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
- Weber A Institute of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland.
- Bauerfeind P Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
- Samaras P Oncology Centre, Hirslanden Medical Center, Zurich, Switzerland.
- Lehmann K Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
- 2018-05-11
Published in:
- BMC cancer. - 2018
AEG
Gastric cancer
Histopathologic regression
PET-CT
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Cardia
Endosonography
Esophagogastric Junction
Feasibility Studies
Female
Fluorodeoxyglucose F18
Gastrectomy
Humans
Male
Middle Aged
Neoadjuvant Therapy
Positron Emission Tomography Computed Tomography
Predictive Value of Tests
Prognosis
Radiopharmaceuticals
Retrospective Studies
Sensitivity and Specificity
Stomach Neoplasms
Treatment Outcome
English
BACKGROUND
Pathologic response to neoadjuvant chemotherapy (neoCTX) is a prognostic factor in many cancer types, and early prediction would help to modify treatment. In patients with gastric and esophagogastric junction (AEG) cancer, the accuracy of FDG PET-CT to predict early pathologic response after neoadjuvant chemotherapy (neoCTX) is currently not known.
METHODS
From a consecutive cohort of 72 patients, 44 patients with resectable, locally-advanced gastric cancer or AEG Siewert type II and III received neoCTX after primary staging with endoscopic ultrasound, PET-CT and laparoscopy. Overall, 14 patients did not show FDG uptake, and the remaining 30 were restaged by PET-CT 14 days after the first cycle of neoCTX. Metabolic response was defined as decrease of tumor standardized uptake value (SUV) by ≥35%. Major pathologic regression was defined as less than 10% residual tumor cells.
RESULTS
Metabolic response after neoCTX was detected in 20/30 (66.7%), and non-response in 10/30 (33.3%) patients. Among metabolic responders, n = 10 (50%) showed major and n = 10 (50%) minor pathologic regression. In non-responders, n = 9 (90%) had minor and 1 (10%) a major pathologic regression. This resulted in a sensitivity of 90.9%, specificity 47.3%, positive predictive value 50%, negative predictive value 90% and accuracy of 63.3%.
CONCLUSION
Response PET-CT after the first cycle of neoCTX does not accurately predict overall pathologic response. However, PET-CT reliably detects non-responders, and identifies patients who should either immediately proceed to resection or receive a modified multimodality therapy.
TRIAL REGISTRATION
The trial was registered and approved by local ethics committee PB_2016-00769.
Pathologic response to neoadjuvant chemotherapy (neoCTX) is a prognostic factor in many cancer types, and early prediction would help to modify treatment. In patients with gastric and esophagogastric junction (AEG) cancer, the accuracy of FDG PET-CT to predict early pathologic response after neoadjuvant chemotherapy (neoCTX) is currently not known.
METHODS
From a consecutive cohort of 72 patients, 44 patients with resectable, locally-advanced gastric cancer or AEG Siewert type II and III received neoCTX after primary staging with endoscopic ultrasound, PET-CT and laparoscopy. Overall, 14 patients did not show FDG uptake, and the remaining 30 were restaged by PET-CT 14 days after the first cycle of neoCTX. Metabolic response was defined as decrease of tumor standardized uptake value (SUV) by ≥35%. Major pathologic regression was defined as less than 10% residual tumor cells.
RESULTS
Metabolic response after neoCTX was detected in 20/30 (66.7%), and non-response in 10/30 (33.3%) patients. Among metabolic responders, n = 10 (50%) showed major and n = 10 (50%) minor pathologic regression. In non-responders, n = 9 (90%) had minor and 1 (10%) a major pathologic regression. This resulted in a sensitivity of 90.9%, specificity 47.3%, positive predictive value 50%, negative predictive value 90% and accuracy of 63.3%.
CONCLUSION
Response PET-CT after the first cycle of neoCTX does not accurately predict overall pathologic response. However, PET-CT reliably detects non-responders, and identifies patients who should either immediately proceed to resection or receive a modified multimodality therapy.
TRIAL REGISTRATION
The trial was registered and approved by local ethics committee PB_2016-00769.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s12885-018-4477-4
- PMID 29743108
- Persistent URL
- https://sonar.ch/global/documents/298863
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