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Background <p>To evaluate the prognostic value of [<sup>18</sup>F]fluorodeoxyglucose (FDG) PET/CT in patients with recurrent or metastatic esophageal cancer treated with anti-programmed death 1 (PD-1) inhibitors and chemotherapy.</p> Methods <p>This retrospective study enrolled 43 patients treated with anti-PD-1 inhibitors plus chemotherapy between March 2022 and June 2025. We analyzed pre-therapeutic maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Associations with overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier and Cox regression analyses. Subgroup analyses evaluated early metabolic changes in patients with follow-up PET/CT (<i>n</i> = 15) and metabolic trajectory in those with initial staging PET/CT (<i>n</i> = 19).</p> Results <p>Forty-three patients (mean age, 65.0 ± 8.5 years; 34 men) were evaluated. High pre-therapeutic SUVmax, SUVmean, MTV, and TLG were significantly associated with poor OS based on the likelihood ratio test from univariate Cox regression (all <i>p</i> &lt; 0.05). While pre-therapeutic parameters did not predict PFS, early reductions in volumetric parameters (Δ%MTV and Δ%TLG) on follow-up PET/CT were significantly associated with PFS (<i>p</i> &lt; 0.05). Furthermore, patients exhibiting a “high-to-low” metabolic trajectory from initial staging to pre-therapeutic baseline demonstrated superior PFS compared to the “low-to-high” group (<i>p</i> = 0.02 for SUVmax; <i>p</i> &lt; 0.001 for SUVmean).</p> Conclusions <p>FDG PET/CT parameters were associated with survival outcomes; pre-therapeutic metabolic burden predicts OS, whereas dynamic metabolic changes and longitudinal trajectory showed associations with PFS in patients treated with chemo-immunotherapy.</p>

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Prognostic value of [18F]fluorodeoxyglucose PET/CT in esophageal cancer patients treated with anti-PD-1 inhibitors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Wonseok Whi,
  • Jong-Mu Sun,
  • Joon Young Choi,
  • Hyunjong Lee

摘要

Background

To evaluate the prognostic value of [18F]fluorodeoxyglucose (FDG) PET/CT in patients with recurrent or metastatic esophageal cancer treated with anti-programmed death 1 (PD-1) inhibitors and chemotherapy.

Methods

This retrospective study enrolled 43 patients treated with anti-PD-1 inhibitors plus chemotherapy between March 2022 and June 2025. We analyzed pre-therapeutic maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Associations with overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier and Cox regression analyses. Subgroup analyses evaluated early metabolic changes in patients with follow-up PET/CT (n = 15) and metabolic trajectory in those with initial staging PET/CT (n = 19).

Results

Forty-three patients (mean age, 65.0 ± 8.5 years; 34 men) were evaluated. High pre-therapeutic SUVmax, SUVmean, MTV, and TLG were significantly associated with poor OS based on the likelihood ratio test from univariate Cox regression (all p < 0.05). While pre-therapeutic parameters did not predict PFS, early reductions in volumetric parameters (Δ%MTV and Δ%TLG) on follow-up PET/CT were significantly associated with PFS (p < 0.05). Furthermore, patients exhibiting a “high-to-low” metabolic trajectory from initial staging to pre-therapeutic baseline demonstrated superior PFS compared to the “low-to-high” group (p = 0.02 for SUVmax; p < 0.001 for SUVmean).

Conclusions

FDG PET/CT parameters were associated with survival outcomes; pre-therapeutic metabolic burden predicts OS, whereas dynamic metabolic changes and longitudinal trajectory showed associations with PFS in patients treated with chemo-immunotherapy.