BACKGROUND: Clinical staging modalities for esophageal cancer are inaccurate at determining prognosis, especially in early-stage patients. We performed a retrospective review of patients with esophageal adenocarcinoma imaged by positron emission tomography before surgical resection to determine whether 18[F]-fluorodeoxyglucose uptake predicted overall survival independently of clinical and pathologic stage. METHODS: The study is a retrospective review of patients with adenocarcinoma of the esophagus treated by surgery. All patients were imaged with computed tomography and positron emission tomography imaging, and most patients had an endoscopic ultrasound. We compared positron emission tomography standardized uptake values (SUVmax) with clinical and pathologic stage and survival. Prognostic variables were assessed by log-rank test, and survival by the method of Kaplan and Meier. RESULTS: From January 1996 through June 2004, 50 patients meeting study eligibility criteria were analyzed. Median follow-up for surviving patients was 27 months. The median SUVmax was 4.5. Stratification of patients by the median SUVmax predicted survival. The 3-year survival was 57% for patients with an SUVmax greater than 4.5 and 95% for patients with an SUVmax of 4.5 or less (p = 0.02). The survival advantage of the SUVmax 4.5 or less group was also seen in clinically early-stage patients (defined as no adenopathy on computed tomography and positron emission tomography, and by endoscopic ultrasound T1-2 N0), as well as in patients with pathologically early-stage disease (T-2 N0). CONCLUSIONS: In surgically managed esophageal adenocarcinoma patients, SUVmax predicts overall survival. Moreover, SUVmax identifies patients who have a poor prognosis from a subset of patients that would otherwise be considered to have early-stage disease.
