Heterogeneity of Glucose Metabolism in Esophageal Cancer Measured by Fractal Analysis of Fluorodeoxyglucose Positron Emission Tomography Image: Correlation between Metabolic Heterogeneity and Survival

Authors:
  • KSKiyohiko Shuto
    Kiyohiko Shuto
  • TKTsuguaki Kono
    Tsuguaki Kono
  • GOGaku Ohira
    Gaku Ohira
  • TTTakayuki Tohma
    Takayuki Tohma
  • HGHisashi Gunji
    Hisashi Gunji
  • KHKoichi Hayano
    Koichi Hayano
  • KNKazuo Narushima
    Kazuo Narushima
  • TFTakeshi Fujishiro
    Takeshi Fujishiro
  • THToshiharu Hanaoka
    Toshiharu Hanaoka
  • YAYasunori Akutsu
    Yasunori Akutsu
  • SOShinichi Okazumi
    Shinichi Okazumi
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Abstract
Background: Intratumoral heterogeneity is a well-recognized characteristic feature of cancer. The purpose of this study is to assess the heterogeneity of the intratumoral glucose metabolism using fractal analysis, and evaluate its prognostic value in patients with esophageal squamous cell carcinoma (ESCC). Methods: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) studies of 79 patients who received curative surgery were evaluated. FDG-PET images were analyzed using fractal analysis software, where differential box-counting method was employed to calculate the fractal dimension (FD) of the tumor lesion. Maximum standardized uptake value (SUVmax) and FD were compared with overall survival (OS). Results: The median SUVmax and FD of ESCCs in this cohort were 13.8 and 1.95, respectively. In univariate analysis performed using Cox's proportional hazard model, T stage and FD showed significant associations with OS (p = 0.04, p < 0.0001, respectively), while SUVmax did not (p = 0.1). In Kaplan-Meier analysis, the low FD tumor (Conclusion: Metabolic heterogeneity measured by fractal analysis can be a novel imaging biomarker for survival in patients with ESCC.