The prognosis of patients with pancreatic adenocarcinoma is usually very poor; the prediction of survival by clinicopathologic features is often difficult. Recently, the uptake of 18-FDG in PET scan has been found to be correlated with survival in patients with pancreatic cancer. Aim of this study was to evaluate the role of 18-FDG PET as prognostic factor for the patients with pancreatic adenocarcinoma. From 1996 to 2001 48 out of 106 patients who had a PET scan in the preoperative work-up for pancreatic cancer, received also an additional abdominal PET scan with semiquantitative analysis of the uptake. The standardized uptake value (SUV: n.v <2.5) was obtained, and the patients were divided in two groups, according to pathological SUV < or > 4. Patients were evaluated according to TNM (UICC) classification, gradig of the tumor, and type of operation. Survival curves were prepared using the Kaplan-Meier method, and statistical comparisons were made by log-rank test. A Cox proportional-hazards analysis was used to determine the independent variables that influenced survival. Significance was considered as p< 0.05. Results: There were 25 males and 23 females, with mean age 66.3 years (range 48-82 years). Fifteen patients underwent pancreatic resection, 15 bypass surgery, and 18 were not operated. According to TNM staging the patients were found as follows: stage I in 2 patients, stage III in 14, stage IVa in 14, and stage IVb in 18. Twelve patients showed a well differentiated tumor while 21 had a moderate and 15 a poor differentiated or undifferentiated tumor. Twenty-five cancers showed SUV values < 4, and 23 SUV > 4. Survival was significantly influenced by tumor stage (p < 0.001) when divided in two groups (stage IVb vs. stage IVa, III and I), grading (p= 0.007) and by SUV value (p=0.01). Multivariate analysis showed that stage (p=0.004), grading (p= 0.005), and SUV (p= 0.032) were independent predictors of survival. When the patients analyzed for SUV value, were stratified according to TNM stage, FDG uptake was related to survival (p=0.023) only in those patients without distant metastases. Conclusions: SUV determination in abdominal FDG-PET provides informations of prognostic relevance in patients with pancreatic cancer before surgery or medical treatment, and may therefore be useful in the selection of patients for therapeutic management.