Lymph Node Metastases Diagnosed by 18F-FDG-PET/CT in Esophageal Squamous Cell Cancer Treated With Concurrent Chemoradiotherapy

Background/Aim: To evaluate whether factors related to the clinical staging of lymph node (LN) metastasis diagnosed by F-18-fluorodeoxyglucose positron-emission tomography/computed tomography (PET/CT) correspond to poor survival in esophageal squamous cell cancer (ESCC) patients treated with concurrent chemoradiotherapy (CCRT). Patients and Methods: A total of 69 patients with curative intent and no prior treatment for ESCC or simultaneous treatment for synchronous cancers were investigated. A maximum standardized uptake value (SUVmax) on the highest image pixel in the LN >= 2.5 was considered positive. Location of the involved LN and its impact on survival were analyzed. Results: In the univariate analysis of location, metastasis of the abdominal site, regional abdominal LN, and left gastric LN station negatively affected overall survival (OS) and disease-free survival (DFS). Other adverse clinical factors influencing OS included T4, clinical stage IVA and body mass index <21.2. In terms of DFS, a further unfavorable factor was primary tumor SUVmax >= 10.4. Abdominal site LN metastasis affected both OS and DFS in multivariate analysis. Conclusion: LN metastasis diagnosed by PET/CT in abdominal sites was an independent predictor affecting both OS and DFS in ESCC patients who underwent curative CCRT.