Predictive Value of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve for Survival in Patients with Esophageal Cancer Following Esophagectomy.

Objective: This study aimed to assess the predictive value of CT-FFR on survival in patients with esophageal carcinoma (EC) after esophagectomy.

Methods: Five hundred and eighty patients with EC who had coronary computed tomography angiography (CCTA) and esophagectomy from January 2012 to September 2023 were included in this study. The lesion-specific fractional flow reserve (FFR) was derived from CCTA. The 580 post-esophagectomy EC patients were divided into two groups: CT-FFR > 0.80 (n = 406) and CT-FFR ≤ 0.80 (n = 174). Propensity score matching (PSM) analysis was used to control for confounding factors. Overall survival (OS) was estimated using Kaplan-Meier curves and Cox proportional hazards models based on univariate and multivariate screening of variables.

Results: The CT-FFR ≤ 0.80 group had a higher proportion of males, more patients with coronary artery calcium score (CACS) ≥ 100, lower tumor stages, a higher proportion of patients receiving neoadjuvant therapy, and a higher proportion of patients undergoing full laparoscopy surgery (all p < 0.05). After PSM, the two matched groups of patients had similar characteristics. In our Cox regression model, CT-FFR ≤ 0.80 was an independent factor associated with OS (HR: 1.37; 95% CI: 1.038-1.818; p = 0.026) compared to CT-FFR > 0.80. The results after PSM still showed that CT-FFR ≤ 0.80 was an independent factor associated with OS (HR: 1.43; 95% CI: 1.022-2.009; p = 0.037) compared to CT-FFR > 0.80.

Conclusion: CT-FFR is found to be a valuable imaging marker in predicting outcomes of EC patients following esophagectomy. Specifically, a CT-FFR ≤ 0.80 is associated with poorer survival outcomes in EC patients. This underscores the incremental prognostic value of CT-FFR in predicting survival outcomes among post-esophagectomy patients.