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This prospective study aimed to compare the predictive value of fluorine-18 fluorodeoxyglucose (\n 18<\/jats:sup>\n F-FDG) and fluorine-18 fluorothymidine (\n 18<\/jats:sup>\n F-FLT) positron emission tomography\/computed tomography (PET\/CT) regarding long-term clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Between June 2018 and July 2019, 31 patients with LA-ESCC were prospectively enrolled and underwent both\n 18<\/jats:sup>\n F-FDG and\n 18<\/jats:sup>\n F-FLT PET\/CT scans prior to or during initial therapy. Quantitative parameters, including maximum standardized uptake value (SUV\n max<\/jats:sub>\n ), minimum SUV (SUV\n min<\/jats:sub>\n ), mean SUV (SUV\n mean<\/jats:sub>\n ), tumour metabolic volume (MTV), total lesion glycolysis (TLG), and total lesion\n 18<\/jats:sup>\n F-FLT expression (TLT), were measured for primary tumours and regional lymph nodes. Progression-free survival (PFS) and overall survival (OS) were analysed using Cox univariate regression, receiver operating characteristic (ROC) curve analysis, and Kaplan-Meier survival estimates.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In\n 18<\/jats:sup>\n F-FLT PET\/CT, primary tumour parameters (SUV\n max<\/jats:sub>\n , SUV\n mean<\/jats:sub>\n , TLT) and all lymph node parameters significantly distinguished between favourable and poor PFS groups (all P <0.05). Primary tumour SUV\n max<\/jats:sub>\n , SUV\n mean<\/jats:sub>\n , and all lymph node parameters demonstrated a negative correlation with both PFS and OS. Specifically, lymph node SUV max (PFS: hazard ratio (HR)=1.65, 95% confidence interval (CI):1.23\u20132.19, P =0.002; OS: HR = 1.81, 95% CI:1.29\u20132.55, P <0.001) and SUV mean showed strong predictive value. In contrast, for\n 18<\/jats:sup>\n F-FDG PET\/CT, only lymph node MTV differed significantly between PFS groups (P =0.03), with no parameters showing significant prognostic correlation. ROC analysis indicated that\n 18<\/jats:sup>\n F-FLT lymph node SUV\n max<\/jats:sub>\n and SUV\n mean<\/jats:sub>\n yielded the highest predictive accuracy for PFS (area under the curve (AUC): 83.8% and 84.2%, respectively) and OS (AUC: 79.3% for both).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n 18<\/jats:sup>\n F-FLT PET\/CT may offer superior prognostic value compared to\n 18<\/jats:sup>\n F-FDG PET\/CT for long-term survival prediction in LA-ESCC. Parameters derived from metastatic lymph nodes, particularly SUV\n max<\/jats:sub>\n and SUV\n mean<\/jats:sub>\n , may serve as potential biomarkers for poor clinical outcomes, independent of imaging timing.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s40644-026-01056-2","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T12:55:34Z","timestamp":1780664134000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term prognostic value of 18F-FLT PET\/CT versus 18F-FDG PET\/CT in locally advanced oesophageal squamous cell carcinoma: a prospective study"],"prefix":"10.1186","volume":"26","author":[{"given":"Wenyan","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwen","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Zhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuzhong","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qifeng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"1056_CR1","first-page":"1","volume":"2","author":"R Zheng","year":"2022","unstructured":"Zheng R, Zhang S, Zeng H, Wang S, Sun K, Chen R, et al. 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