PD05.04. Clinical Value of Tumor and Host Metabolic Dynamics on Serial 18F-FDG PET in Locally Advanced Resectable Esophageal Squamous Cell Carcinoma

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ID: 326115
2026
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Abstract
Abstract Topic Esophageal Cancer: New Diagnostic Modalities (Including PET, PET-CT, New Tracers) Background We evaluated whether serial 18F-FDG PET–derived metabolic changes in tumor and host response are associated with pathologic complete response (pCR) and survival in patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC), addressing the limited ability of baseline-to-preoperative PET response to detect substantial residual disease and to differentiate viable tumor from post-treatment inflammation. Methods We enrolled 38 patients from 2 phase II clinical trials (NCT03623737 and NCT05130684) with locally advanced, resectable ESCC who underwent serial 18F-FDG PET/CT at three predefined time points: initial staging (PET1), approximately 3 weeks after completion of neoadjuvant concurrent chemoradiotherapy (PET2), and before surgery (PET3). Tumor metabolic parameters, including maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis, were quantified at each scan. Host-response metabolic activity was assessed using spleen-to-liver uptake ratio, bone marrow SUV, and subcutaneous and visceral adipose tissue SUVs. Both single–time point measurements and interval-based relative percentage changes were calculated across PET1–PET2, PET2–PET3, and PET1–PET3. Associations between serial PET-derived tumor and host-response metrics with pCR and survival outcomes were evaluated using appropriate regression and survival analyses. Logistic and Cox regression were used to model pCR and overall survival (OS), respectively. Results Among 38 enrolled patients, 35 underwent surgical resection; three were excluded from surgery due to esophagopulmonary fistula, intraoperative pleural seeding, or interstitial lung disease. pCR was achieved in 13 patients. The interval between PET2 and PET3 differed significantly between groups, whereas other clinical characteristics were balanced. Single–time point PET-derived tumor and host metabolic parameters showed no significant group differences. In contrast, relative changes in tumor SUVmax and visceral adipose tissue SUV from PET2 to PET3 were significantly associated with pCR (both p<0.05). On logistic regression, both parameters independently predicted pCR, with and without adjustment for the PET2–PET3 interval. A combined tumor–host model improved discrimination compared with single-parameter models; however, only tumor SUVmax change remained independently significant. During a median follow-up of 660 days, 10 deaths occurred. Tumor SUVmax change from PET2 to PET3 was a significant prognostic factor (HR 1.02, 95% CI 1.004–1.03; P=0.01). Conclusion Dynamic tumor metabolic change between post-chemoradiotherapy and preoperative PET (PET2–PET3) is a major determinant of pCR in locally advanced resectable esophageal squamous cell carcinoma. Incorporation of host metabolic metrics enhances overall model discrimination, supporting a complementary biologic role. Importantly, dynamic tumor metabolic change from PET2 to PET3 also serves as an independent predictor of OS, underscoring the clinical value of longitudinal PET assessment.
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Authors Kuan‐Yin Ko, Ta‐Chen Huang, Chien-Huai Chuang, Chih‐Hung Hsu, Jhe‐Cyuan Guo, Hung‐Yang Kuo, Chia-Chi Lin, Tsung‐Che Wu, Jason Chia‐Hsien Cheng, Feng‐Ming Hsu, Pei‐Ming Huang, Jang‐Ming Lee
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.107
URL
https://doi.org/10.1093/dote/doag077.107
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