Prognostic Value of Sarcopenia and Metabolic Parameters of <sup>18</sup>F-FDG-PET/CT in Patients with Advanced Gastroesophageal Cancer
Ricarda Hinzpeter,
Seyed Ali Mirshahvalad,
Roshini Kulanthaivelu,
Vanessa Murad,
Claudia Ortega,
Ur Metser,
Zhihui Amy Liu,
Elena Elimova,
Rebecca K. S. Wong,
Jonathan Yeung,
Raymond W. Jang,
Patrick Veit-Haibach
Affiliations
Ricarda Hinzpeter
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
Seyed Ali Mirshahvalad
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
Roshini Kulanthaivelu
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
Vanessa Murad
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
Claudia Ortega
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
Ur Metser
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
Zhihui Amy Liu
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
Elena Elimova
Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
Rebecca K. S. Wong
Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
Jonathan Yeung
Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
Raymond W. Jang
Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
Patrick Veit-Haibach
Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
We investigated the prognostic value of sarcopenia measurements and metabolic parameters of primary tumors derived from 18F-FDG-PET/CT among patients with primary, metastatic esophageal and gastroesophageal cancer. A total of 128 patients (26 females; 102 males; mean age 63.5 ± 11.7 years; age range: 29–91 years) with advanced metastatic gastroesophageal cancer who underwent 18F-FDG-PET/CT as part of their initial staging between November 2008 and December 2019 were included. Mean and maximum standardized uptake value (SUV) and SUV normalized by lean body mass (SUL) were measured. Skeletal muscle index (SMI) was measured at the level of L3 on the CT component of the 18F-FDG-PET/CT. Sarcopenia was defined as SMI 2/m2 in women and 2/m2 in men. A total of 60/128 patients (47%) had sarcopenia on baseline 18F-FDG-PET/CT. Mean SMI in patients with sarcopenia was 29.7 cm2/m2 in females and 37.5 cm2/m2 in males. In a univariable analysis, ECOG (p = 0.028), SMI (p = 0.0075) and dichotomized sarcopenia score (p = 0.033) were significant prognostic factors for overall survival (OS) and progression-free survival (PFS). Age was a poor prognostic factor for OS (p = 0.017). Standard metabolic parameters were not statistically significant in the univariable analysis and thus were not evaluated further. In a multivariable analysis, ECOG (p p = 0.019) remained significant poor prognostic factors for OS and PFS. The final model demonstrated improved OS and PFS prognostication when combining clinical parameters with imaging-derived sarcopenia measurements but not metabolic tumor parameters. In summary, the combination of clinical parameters and sarcopenia status, but not standard metabolic values from 18F-FDG-PET/CT, may improve survival prognostication in patients with advanced, metastatic gastroesophageal cancer.
