Prognostic value of initial fluorodeoxyglucose-PET in esophageal cancer: a prospective study

Esophageal cancer outcome greatly depends on the pathological stage. Our objectives were to assess prognosis on the basis of the initial fluorodeoxyglucose (FDG)-PET scan, focusing on the correlation between overall survival and FDG uptake in the primary, as well as the presence of FDG-positive lymph nodes or distant metastases.

Fifty-two esophageal cancer patients undergoing FDG-PET as part of initial routine staging procedure before treatment were included. The maximum standardized uptake value (SUV max) was determined in each primary lesion and the number of abnormalities including primary, lymph nodes, or distant metastases was recorded. Correlation with overall survival was performed using Kaplan-Meier method and Cox regression analysis was used to assess the prognostic value of PET parameters.

Half of the patients were planned for initial curative surgery (52%). Using univariate survival analysis, either surgery, SUV max >9, two or more PET abnormalities or the presence of FDG-positive nodes were significant overall survival prognostic predictors. After multivariate analysis, only SUV max >9 and FDG-positive lymph nodes were found as independent predictors of poor outcome.

In this prospective study, FDG-PET was found to provide prognostic information supporting a new indication for initial FDG-PET examination in esophageal cancer.