Efficacy of cell proliferation imaging with 4DST PET/CT for predicting the prognosis of patients with esophageal cancer: a comparison study with FDG PET/CT

Masatoshi Hotta, Ryogo Minamimoto, Jun Toyohara, Kyoko Nohara, Kazuhiko Nakajima, Kei Takase, Kazuhiko Yamada

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: 4′-[Methyl-11C] thiothymidine (4DST) incorporates into DNA directly and is a PET tracer used for cell proliferation imaging. The aim of this study was to evaluate the prediction of prognosis with pretreatment 4DST PET/CT compared to fluorodeoxyglucose (FDG) PET/CT in patients with esophageal cancer. Methods: In this prospective study, we analyzed 46 patients (68.2 ± 10.0 years old) with pathologically proven esophageal squamous cell cancer who underwent pretreatment 4DST and FDG PET/CT. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and total lesion proliferation (TLP) were measured for FDG and 4DST PET. The study endpoints were progression-free survival (PFS) and overall survival (OS). Patients’ clinical backgrounds, including age, histological type, clinical stage, and surgical treatment, were adjusted using the Cox proportional-hazards model. Results: In the follow-up period (median 18.8 (interquartile range: 10.1–29.0) months), 26 and 19 patients showed disease progression and cancer-related death, respectively. After adjusting for clinical variables, only the 4DST parameters (SUVmax (p = 0.001) and TLP (p = 0.022)) were statistically significant for predicting PFS. FDG MTV (p = 0.031), 4DST SUVmax (p = 0.022), and TLP (p = 0.023) were statistically significant for predicting OS. Of the PET parameters, 4DST SUVmax yielded the highest adjusted hazard ratio for both PFS (4.88, 95% confidence intervals (CI): 1.83–12.97) and OS (4.19, 95% CI: 1.23–14.20). Conclusion: Higher accumulation of 4DST in the primary tumor may lead to shorter OS and PFS. 4DST PET/CT is useful for predicting prognosis and may outperform FDG PET/CT.

Original languageEnglish
Pages (from-to)2615-2623
Number of pages9
JournalEuropean journal of nuclear medicine and molecular imaging
Volume48
Issue number8
DOIs
Publication statusPublished - 2021 Jul

Keywords

  • 4DST
  • Esophageal cancer
  • FDG
  • Overall survival
  • PET/CT
  • Prognosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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