PurposeThe aim of this study was to investigate the relationship between volume-based quantitative PET parameters and survival in patients with malignant pleural mesothelioma (MPM) and to evaluate the potential value of bone marrow (BM) uptake in predicting prognosis.Materials and methodsWe retrospectively reviewed the data of 51 patients with MPM who underwent initial staging by fluorine-18-fluorodeoxyglucose (F-18-FDG) PET/computerized tomography (PET/CT). F-18-FDG-PET images were visually and quantitatively re-evaluated and maximum standardized uptake values (SUVmax), mean standardized uptake values (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis of primary tumors, and pleural thickening were calculated. In addition, BM and liver uptakes were measured; also, the degree of BM uptake was scored visually. BM/liver ratio and visual BM uptake score were noted. The correlations between quantitative PET parameters, BM uptake, and overall survival were analyzed.Results(18)F-FDG-PET scans upstaged 6 (11.8%) of 51 patients because of detection of previously unknown distant metastasis. On univariate analysis, advanced disease stage, high leukocyte count (10x10(3)/ml), pleural thickening greater than 13mm, SUVmax, SUVmean, MTV, total lesion glycolysis, BM/liver greater than 1.01, and visual score 1 and 2 were negative prognostic factors (P<0.05). In multivariate analysis, SUVmax greater than 8.6 [P=0.027, hazard ratio (HR): 2.961], MTV greater than 112 (P=0.001, HR: 4.861), and visual score 2 (P=0.035, HR: 3.827) were associated independently with a poor prognosis.ConclusionThe presence of distant metastasis is more predictive of survival than PET nodal status in MPM patients. PET/CT has the potential to provide prognostic information in MPM patients and there was a good correlation between overall survival and volume-based PET parameters. Determination of BM uptake may contribute toward the prediction of patient outcome with other quantitative PET parameters.