Abstract:

Objective This study aimed to explore the prognostic value of ¹⁸F?FDG PET/CT Metabolic and Heterogeneity Parameters Combined with Clinical Features Before Definitive Chemoradiotherapy （D?CRT） in predicting the prognosis of esophageal squamous cell carcinoma （ESCC） Patients. Methods A retrospective analysis was conducted on clinical data from 106 patients with ESCC who received D?CRT at the first affiliated Hospital of University of Science and Technology of China between January 2017 and December 2021. All patients underwent ¹⁸F?FDG PET/CT examination before the treatment. The primary tumor's metabolic and heterogeneity parameters were obtained through data processing. All patients were followed up for overall survival. The Kaplan?Meier method and Cox proportional hazards models were used to analyze the association between clinical features， tumor metabolism and heterogeneity parameters and patient prognosis. Results The 1? and 1.5?year overall survival rates of all patients were 77.4%and 51.9%. The median survival time was 20 months. Univariate analysis showed that N stage， M stage， metabolic tumor volume， total lesion glycolysis， heterogeneity index?2 （HI?2）， and coefficient of variation with a threshold of 40% maximum standard uptake value （CV40%） were correlated with the prognosis of ESCC （all P< 0.05）. Multivariate analysis showed that N stage and CV40% were independent predictors of prognosis in patients with ESCC （P = 0.039 and P < 0.001， respectively）. Conclusion N stage and tumor metabolic heterogeneity parameter CV40%， which offering a degree of predictive value， are closely related to the prognosis of patients with ESCC treated with D?CRT.

Key words: esophageal squamous cell carcinoma, intra?tumor metabolic heterogeneity, intensity?modulated radiotherapy, PET/CT, prognosis