Baseline 18f-FDG Pet/Ct Suvmax as a Prognostic Indicator for Long-Term Survival in Postoperative Esophageal Squamous Cell Carcinoma

Background While 18F-FDG PET/CT plays a critical role in the diagnosis and management of esophageal squamous cell carcinoma (ESCC), and the maximum standardized uptake value (SUVmax) of lymph nodes measured by 18F-FDG PET/CT is commonly utilized to assess lymph node metastasis, limited studies have explored the clinical significance of SUVmax in predicting postoperative long-term survival. This study aimed to evaluate the prognostic value of baseline 18F-FDG PET/CT SUVmax in predicting long-term survival outcomes for ESCC patients following surgery. Methods We retrospectively analyzed patients who underwent surgery with or without neoadjuvant therapy from 2016 to 2019, with a minimum follow-up period of 5 years. Baseline SUVmax values of primary tumors and lymph nodes were collected from pretreatment 18F-FDG PET/CT scans. Patients were stratified into high and low SUVmax groups based on predefined thresholds: primary tumor SUVmax ≤13.5 (low) vs. >13.5 (high), and lymph node SUVmax ≤2.5 (low) vs. >2.5 (high). Survival outcomes were analyzed using the Kaplan–Meier method, and independent prognostic factors for long-term survival were identified via multivariate Cox regression. Results The cohort included 242 patients. Compared to the high tumor SUVmax group, the low SUVmax group exhibited prolonged OS (median not reached vs. 65 months; p = 0.014) and DFS (median not reached vs. 65 months; p = 0.038). Lymph node SUVmax subgroups showed no OS/DFS differences. In neoadjuvant-treated patients, low tumor SUVmax correlated with superior OS (median not reached vs. 37 months; p = 0.010) and DFS (median not reached vs. 14.5 months; p = 0.033). Multivariate analysis identified preoperative high tumor SUVmax (p = 0.039), cN1 (p = 0.033), cN2 (p = 0.008), and postoperative (y)pT4 (p = 0.026), (y)pN1–3 (p = 0.045, 0.003, <0.001) as independent survival predictors. Conclusion Baseline 18F-FDG PET/CT SUVmax holds significant prognostic value for postoperative overall survival in ESCC patients. These findings highlight its potential utility in risk stratification and therapeutic decision-making.