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Prognostic impact of hexokinase and glucose transporter expressions and clinicopathologic features related to F-18-FDG uptake in esophageal cancer.

39 Background: Elucidation of prognostic predictors based on biological viability may be useful for a better detection of patients with a high risk of relapse or death from esophageal cancer.


METHODS
Maximum standardized uptake values (SUVmax) were measured in the preoperative 18F-FDG positron emission tomography (PET) scans of 47 patients who had a radical esophageal resection without previous treatment. Expression levels of hexokinase-II (HK-II), glucose transporter I (GLUT-I), hypoxia inducible factor-1α (HIF-Iα), vascular endothelial growth factor (VEGF), p53 and the proliferative activity (MIB-I score) were determined immunohistochemically on paraffin-embedded tumor tissue. Correlations and survival functions were calculated to identify independent correlations between FDG-uptake and prognostic expression levels.


RESULTS
High HK-II expression was significantly correlated with reduced SUVmax values (p= 0.002) and HK-II expression was significant higher among adenocarcinomas than squamous cell carcinomas (36/37 vs. 5/9, p= 0.004). The five years survival was significant better for patients with SUVmax≤ 3 in their primary tumors (75% vs. 25%) and a lymph node (LN) ratio ≤0.20 (40% vs. 6%). There were also significant disease free survival benefits for different expression rates of GLUT-I, p53 and MIB (log rank p= 0.03, p= 0.03 and p= 0.04 respectively) in patients with a lymph node ratio >0.20.


CONCLUSIONS
FDG-uptake and LN ratio are strong prognostic predictors in patients with esophageal cancer. The level of GLUT-I and p53 expression and the MIB score may be useful prognostic markers that provide information about tumor aggressiviness in esophageal cancer.