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Background  Although  18 F- FDG PET/CT is validated in baseline workup of esophageal cancer to detect distant metastases, it remains underused in assessing local staging and biology of the primary tumor. This study aimed to evaluate the association between  18 F- FDG PET/CT-derived parameters of esophageal cancer, and its clinico-pathological features and prognosis.    Methods  All patients ( n  = 86) with esophageal adenocarcinoma or squamous cell cancer operated between 2005 and 2014 were analyzed. Linear regression was used to identify clinico-pathologic features of esophageal cancer associated with the tumor’s maximal Standardized Uptake Value (SUV max ), Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV). ROC curve analysis was performed to precise the optimal cutoff of each variable associated with a locally advanced (cT3/4) status, long-term survival and recurrence. Kaplan Meier curves and Cox regression were used for survival analyses.    Results  High baseline SUV max  was associated with cT3/4 status and middle-third tumor location, TLG with a cT3/4 and cN+ status, whereas MTV only with active smoking. A cT3/4 status was significantly predicted by a SUV max  > 8.25 g/mL ( p  < 0.001), TLG > 41.7 ( p  < 0.001) and MTV > 10.70 cm 3  ( p  < 0.01) whereas a SUV max  > 12.7 g/mL was associated with an early tumor recurrence and a poor disease-free survival (median 13 versus 56 months,  p  = 0.030), particularly in squamous cell cancer.    Conclusions  Baseline  18 F- FDG PET/CT has a high predictive value of preoperative cT stage, as its parameters SUV max , TLG and MTV can predict a locally advanced tumor with high accuracy. A SUV max  > 12.7 g/mL may herald early tumor recurrence and poor disease-free survival.

18F- FDG PET/CT-derived parameters predict clinical stage and prognosis of esophageal cancer