Standardized Uptake Value (SUV) Measurement as a Predictor of Clinical Outcomes in Patients with Gastrointestinal Cancer

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All articles of this category (opens in new window) Address for correspondence Pedro Luis Serrano Uson (pedro.serrano@einstein.br) Background: The maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT reflects tumor glycolytic activity and has been associated with disease aggressiveness and prognosis in various cancers. However, its clinical utility in gastrointestinal (GI) malignancies remains unclear. Objective: To investigate the association between baseline SUVmax and clinical and molecular outcomes in patients with GI cancers. Methods: We retrospectively analyzed clinical and genomic data from 149 patients with GI malignancies treated at Hospital Israelita Albert Einstein between August 2014 and April 2025. Eligible patients underwent baseline PET/CT within 30 days prior to initiating oncologic therapy. Differences in SUVmax by tumor type, stage, and biomarker status were analyzed using non-parametric tests. Correlations between SUVmax, age, and tumor mutational burden (TMB) were assessed via Spearman coefficients. Overall survival (OS) was estimated using Kaplan–Meier and Cox regression models. Results: The cohort included patients with hepatobiliary (38.7%), colorectal (36.0%), and esophagogastric (22.0%) cancers. Median age was 60.9 years. SUVmax values varied significantly across tumor types (p < 0.0001), with colorectal tumors showing the highest median. No significant difference in SUVmax was observed between localized and metastatic stages (Wilcoxon rank-sum, z=-0,80, p=0.422). Additionally, SUVmax did not differ when layered by HER2 status (z=-1.33, p=0.184), PD-L1 expression (z = 0.53, p = 0.598) or KRAS mutation status (z = 1.22, p = 0.222). TP53 wild-type tumors (n=24) showed a trend toward higher SUVmax compared to TP53-mutated cases (n=20, z-1.93, p=0.053), though without statistical significance. SUVmax showed a weak positive correlation with TMB (ρ = 0.26) and a moderate inverse correlation with age (ρ = –0.40). SUVmax was not significantly associated with OS (HR 1.00; 95% CI 0.97–1.04; p = 0.843). Conclusions: In this cohort of patients with GI tumors, SUVmax was not significantly associated with overall survival, suggesting that, while PET-derived metabolic activity reflects biological variability among GI cancers, its isolated use as a prognostic tool may be limited. Publication History Article published online: 26 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil Bibliographical Record Giovanna Ferreira Fonseca, Maria Fernanda Teixeira, Laura Pernomian, Ana Luisa Spina Nagy, Isabela Prado Checchio, Isabella Sforzin, Francisco Tustumi, Pedro Luis Serrano Uson. Standardized Uptake Value (SUV) Measurement as a Predictor of Clinical Outcomes in Patients with Gastrointestinal Cancer. Brazilian Journal of Oncology 2026; 22. DOI: 10.1055/s-0046-1825287

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