RT Journal Article SR Electronic T1 Prognostic value of pretherapeutic tumor-to-blood standard uptake ratio (SUR) in patients with esophageal carcinoma JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP jnumed.115.155309 DO 10.2967/jnumed.115.155309 A1 Rebecca Bütof A1 Frank Hofheinz A1 Klaus Zöphel A1 Tobias Stadelmann A1 Julia Schmollack A1 Christina Jentsch A1 Steffen Löck A1 Jörg Kotzerke A1 Michael Baumann A1 Jörg van den Hoff YR 2015 UL http://jnm.snmjournals.org/content/early/2015/06/17/jnumed.115.155309.abstract AB Despite ongoing efforts to develop new treatment options the prognosis for patients with inoperable esophageal carcinoma is still poor and the reliability of individual therapy outcome prediction based on clinical parameters is not convincing. The aim of this work was to investigate if PET can provide independent prognostic information in such a patient group and if the tumor-to-blood standard uptake ratio (SUR) can improve the prognostic value of tracer uptake values. Methods: FDG-PET/CT was performed in 130 consecutive patients ((63 ± 11)years, 113 males) with newly diagnosed esophageal cancer prior to definitive radiochemotherapy. In the PET images the metabolic active volume (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. SUR values were computed as ratio of tumor SUV and blood SUV. Uptake values were scan-time corrected to 60min p.i. Univariate Cox regression and Kaplan-Meier analysis with respect to overall survival (OS), distant-metastases-free survival (DM) and locoregional control (LRC) was performed. Additionally, a multivariate Cox regression including clinically relevant parameters was performed. Results: In multivariate Cox regression with respect to OS, including T-stage, N-stage and smoking state, MTV and SUR based parameters were significant prognostic factors for OS with similar effect size. Multivariate analysis with respect to DM revealed smoking state, MTV and all SUR based parameters as significant prognostic factors. The highest hazard ratios were found for scan-time corrected SURmax (HR=3.9) and SURmean (HR=4.4). None of the PET parameters was associated with LRC. Univariate Cox regression with respect to LRC revealed only for N-stage>0 a significant effect (P = 0.048). Conclusion: PET provides independent prognostic information for OS and DM but not for LRC in patients with locally advanced esophageal carcinoma treated with definitive radio(chemo)therapy in addition to clinical parameters. Among the investigated uptake based parameters only SUR was an independent prognostic factor for OS and DM. These results suggest that the prognostic value of tracer uptake can be improved when characterized by SUR instead of SUV. Further investigations are required to confirm these preliminary results.