%0 Journal Article %A Rebecca Bütof %A Frank Hofheinz %A Klaus Zöphel %A Julia Schmollack %A Christina Jentsch %A Sebastian Zschaeck %A Jörg Kotzerke %A Jörg van den Hoff %A Michael Baumann %T Prognostic Value of Standardized Uptake Ratio in Patients with Trimodality Treatment of Locally Advanced Esophageal Carcinoma %D 2019 %R 10.2967/jnumed.117.207670 %J Journal of Nuclear Medicine %P 192-198 %V 60 %N 2 %X The prognosis of patients with esophageal carcinoma remains dismal despite ongoing efforts to improve treatment options. For locally advanced tumors, several randomized trials have shown the benefit of neoadjuvant chemoradiation followed by surgery compared with surgery alone. The aim of this exploratory study was to evaluate the prognostic value of different baseline PET parameters and their potentially additional prognostic impact at the end of neoadjuvant radiochemotherapy. Furthermore, the standardized uptake ratio (SUR) as a new parameter for quantification of tumor metabolism was compared with the conventional PET parameters metabolically active tumor volume (MTV), total lesion glycolysis (TLG), and SUV, taking into account known basic parameters. Methods: 18F-FDG PET/CT was performed on 76 consecutive patients (60 ± 10 y old, 71 men) with newly diagnosed esophageal cancer before and during the last week of neoadjuvant radiochemotherapy. MTV of the primary tumor was delineated with an adaptive threshold method. The blood SUV was determined by manually delineating the aorta in the low-dose CT scan. SURs were computed as the scan time–corrected ratio of tumor SUVmax and mean blood SUV. Univariate Cox regression and Kaplan–Meier analysis with respect to locoregional control (LRC), freedom from distant metastases (FFDM), and overall survival (OS) was performed. Additionally, the independence of PET parameters from standard clinical factors was analyzed with multivariate Cox regression. Results: In multivariate analysis, 2 parameters showed a significant correlation with all endpoints: restaging MTV and restaging SUR. Furthermore, restaging TLG was prognostic for LRC and FFDM. For all endpoints, the largest effect size was found for restaging SUR. The only basic factors remaining significant in multivariate analyses were histology for OS and FFDM and age for LRC. Conclusion: PET provides independent prognostic information for OS, LRC, and FFDM in addition to standard clinical parameters in this patient cohort. Our results suggest that the prognostic value of tracer uptake can be improved when characterized by SUR rather than by SUV. Overall, our investigation revealed a higher prognostic value for restaging parameters than for baseline PET; therapy adjustments would still be possible at that time. Further investigations are required to confirm these hypothesis-generating results. %U https://jnm.snmjournals.org/content/jnumed/60/2/192.full.pdf