Prognostic assessment of pre- and post-neoadjuvant SUVs via 18F-FDG PET/CT in esophageal cancer patients.

e16003 Background: Esophageal cancer (EC) ranks as the seventh most common cancer globally, with a particularly high prevalence in middle- and low-income countries . The role of functional imaging, specifically positron emission tomography–computed tomography (PET–CT), is becoming increasingly important in assessing EC and its impact on survival. This study aimed to evaluate the prognostic significance of pre- and post-neoadjuvant standardized uptake values (SUVs) in both tumor and nodal regions using 18F-FDG PET/CT scans in patients with EC. Methods: A retrospective analysis was conducted, including 42 patients with biopsy-confirmed EC from January 2020 to March 2024, who underwent pre- and post-neoadjuvant 18F-FDG PET/CT scans to assess SUV in both tumor and nodal regions. Data was sourced from Surgical Unit-1, Dr. Ruth K.M. Pfau Civil Hospital Karachi. Clinicopathological characteristics were evaluated, and cox regression models were employed to evaluate the association between SUV values and overall survival (OS), with cut-off values for SUV determined via ROC analysis. Results: The study included 42 patients with a mean age of 45.5 ± 12.1 years. The mean overall survival was 3.2 years, with an OS rate of 71.4%. A significant mean difference was found between pre- and post-neoadjuvant SUV tumor values (Mean difference = 7.3, p-value < 0.001). Higher pre-neoadjuvant SUV nodal values (≥ 2.4) were associated with significantly poorer OS (p = 0.002). Similarly, post-neoadjuvant SUV tumor values (≥ 1.7) and SUV nodal values (≥ 3.4) were significantly linked to worse OS (p = 0.033 and p < 0.001, respectively). Multivariate analysis further confirmed that both pre-neoadjuvant SUV nodal values (HR = 5.28, p = 0.034) and post-neoadjuvant SUV nodal values (HR = 52.99, p = 0.012) were independent predictors of mortality. Conclusions: Higher pre- and post-neoadjuvant SUV values, particularly in nodal regions, are significant predictors of mortality in EC patients and could serve as valuable indicator for guiding prognosis.