Prognostic Value of Preoperative Positron Emission Tomography in Resected Stage I Non-small Cell Lung Cancer

Purpose Approximately 20 to 40% of patients with surgically resected stage I non-small cell lung cancer (NSCLC) will develop recurrent disease. Positron emission tomography (PET) with 2-[ 18 F] fluoro-2-deoxy-D-glucose (FDG) is used often in staging NSCLC. We conducted this study to determine whether the preoperative maximum tumor standardized uptake value (SUV max ) was associated with recurrence in patients with resected stage I NSCLC. Patients and Methods We identified consecutive patients who underwent curative surgical resection for stage I NSCLC between 1999 and 2003 who had preoperative FDG-PET imaging. Patients were divided into two cohorts based on SUV max above or below the median for the group. Recurrence rates were estimated by the Kaplan-Meier method and overall survival was analyzed as a secondary end point. Results Of 136 patients who met inclusion criteria, 77 (57%) had T1 and 59 (43%) had T2 tumors. The median follow-up time was 46 months and 32 patients had a disease recurrence. The median SUV max was 5.5. The 5-year estimates of recurrence rates for patients with low and high SUV max were 14% and 37%, respectively ( p = 0.002), with 5-year overall survivals of 74% and 53%, respectively ( p = 0.006). In multivariate analyses based on SUV max , T-classification, age, and histology, high SUV max was independently associated with recurrence ( p = 0.002) and mortality ( p = 0.041). Conclusion High SUV max (≥5.5) on preoperative FDG-PET is an independent predictor of relapse and death in resected stage I NSCLC. Prospective trials of adjuvant chemotherapy in patients with stage I NSCLC and high SUV max should be considered.