This study aimed to determine whether ¹⁸F-FDG PET response after induction chemotherapy before concurrent chemoradiotherapy can identify patients with esophageal adenocarcinoma who may benefit from subsequent esophagectomy. Methods: We identified and analyzed 220 patients with esophageal adenocarcinoma who had received induction chemotherapy before chemoradiotherapy, with or without surgery, with curative intent; all underwent ¹⁸F-FDG PET scanning before and after induction chemotherapy. ¹⁸F-FDG PET responders were defined as patients who achieved complete response (CR) after induction chemotherapy (maximum SUV ≤ 3.0). The predictive value of ¹⁸F-FDG PET response for patient outcomes was evaluated. Results: Overall, 86 patients had bimodality therapy (BMT; induction chemotherapy + chemoradiotherapy) and 134 had trimodality therapy (TMT; induction chemotherapy + chemoradiotherapy with surgery). Forty-eight patients (21.8%) achieved an ¹⁸F-FDG PET CR after induction chemotherapy. ¹⁸F-FDG PET CR was found to correlate with overall survival (OS) and progression-free survival (PFS) in BMT patients. For TMT patients, ¹⁸F-FDG PET CR predicted pathologic response (P = 0.003) but not survival. Among ¹⁸F-FDG PET nonresponders, TMT patients had significantly better survival than did BMT patients (P < 0.001). However, among ¹⁸F-FDG PET responders, BMT patients had OS (P = 0.201) and PFS (P = 0.269) similar to that of TMT patients. After propensity score-matched analysis, ¹⁸F-FDG PET responders treated with BMT versus TMT still had comparable OS and PFS, but TMT was associated with better locoregional control. Conclusion: ¹⁸F-FDG PET response to induction chemotherapy could be a useful imaging biomarker to identify patients with esophageal adenocarcinoma who could benefit from subsequent esophagectomy after chemoradiotherapy. Compared with BMT, TMT can significantly improve survival in ¹⁸F-FDG PET nonresponders. However, outcomes for ¹⁸F-FDG PET responders were similar after either treatment (BMT or TMT). Prospective validation of these findings is warranted.

这项研究旨在确定诱导化疗后同步放化疗前的¹⁸ F-FDG PET反应是否可以识别出可能从随后的食管切除术中受益的食管腺癌患者。方法：我们确定并分析了220例食管腺癌患者，这些患者在放化疗前接受了诱导化学疗法，无论是否手术，均具有治愈意图。所有患者在诱导化疗前后均进行了¹⁸ F-FDG PET扫描。^18名F-FDG PET应答者定义为在诱导化疗后达到完全应答（CR）（最大SUV≤3.0）的患者。评价了¹⁸ F-FDG PET反应对患者预后的预测价值。结果：总共有86例患者接受了双峰疗法（BMT；诱导化疗+放化疗），其中134例接受了三峰疗法（TMT；诱导化疗+放化疗联合手术）。诱导化疗后，有48名患者（21.8％）达到了¹⁸ F-FDG PET CR。^发现18 F-FDG PET CR与BMT患者的总生存期（OS）和无进展生存期（PFS）相关。对于TMT患者，¹⁸ F-FDG PET CR可以预测病理反应（P = 0.003），但不能预测生存。在^18名F-FDG PET无反应者中，TMT患者的生存率明显高于BMT患者（P <0.001）。然而，在¹⁸F-FDG PET应答者，BMT患者的OS（P = 0.201）和PFS（P = 0.269）与TMT患者相似。在倾向得分匹配分析之后，BMT与TMT相比，^18名F-FDG PET应答者的OS和PFS仍然相当，但是TMT与更好的局部区域控制相关。结论： ¹⁸ F-FDG PET对诱导化疗的反应可能是鉴别食管腺癌患者的有用的影像学生物标志物，这些患者可以从放化疗后的食管切除术中受益。与BMT相比，TMT可以显着提高^18个F-FDG PET无反应者的生存率。但是，结果¹⁸两种治疗（BMT或TMT）后的F-FDG PET应答者相似。对这些发现进行前瞻性验证是必要的。