Prognostic Significance of Pre‐ and Posttreatment ¹⁸ F‐FDG PET/CT‐Derived SUV‐max in Esophageal Cancer: A South Asian Perspective

Background Esophageal cancer (EC) is a leading cause of cancer‐related deaths globally, with South Asia bearing a particularly high disease burden. While 18 F‐FDG PET/CT‐derived SUV‐max values are explored for their prognostic relevance, previous findings remain inconsistent, and data from South Asian populations are limited. Methods This retrospective study analyzed data from 42 biopsy‐confirmed EC patients treated between June 2019 and December 2024 at a tertiary care center. All included patients had initially received standardized neoadjuvant chemoradiotherapy and underwent both pre‐ and posttreatment 18F‐FDG PET/CT imaging. Associations between clinicopathological factors and survival status were evaluated using the independent t ‐test, Chi‐square test, and Fisher’s exact test. Receiver operating characteristic (ROC) analysis was performed to determine optimal SUV‐max cutoffs. Survival outcomes were assessed using Kaplan–Meier estimates, log‐rank test, and Cox proportional hazards regression to identify independent predictors of mortality. Results Kaplan–Meier analysis showed significantly reduced survival in patients with elevated nodal SUV‐max values both pre‐ and posttreatment. In multivariate Cox regression, posttreatment nodal SUV‐max was the strongest independent predictor of mortality (HR = 52.9, p = 0.012), followed by pretreatment nodal SUV‐max (HR = 15.3, p = 0.034), while tumor SUV‐max values (pre‐ and posttreatment) did not demonstrate independent prognostic significance. Conclusions Nodal SUV‐max on PET/CT is a strong, independent predictor of survival in EC and may effectively guide personalized treatment decisions.