Should preoperative FDG uptake on PET/CT guide postoperative surveillance in surgical non-small cell lung cancer (NSCLC)

Introduction There is no consensus regarding modality or timing for postoperative surveillance in patients undergoing surgery with curative intent for early stage NSCLC. Some suggest that preoperative PET/CT Standard Uptake Variable (SUV) scores may identify patients at higher risk of poor outcomes 1 . We aimed to assess if preoperative FDG uptake highlights subgroups likely to benefit from more intensive postsurgical surveillance. Methods We retrospectively reviewed 82 patients with stage 1-2 NSCLC undergoing surgery with curative intent between 2011 and 2015. Analysis was performed in quartiles defined by preoperative PET SUVmax scores. Results Median time to first postoperative imaging was 3 months, with CT the chosen modality in 56%. Adenocarcinoma accounted for 62% of surgical resections and 69% of recurrences. 57% of patients with recurrent disease had undergone lobectomy. Overall recurrence rate was 17% (64% pulmonary) with mortality of 71%. The highest quartile group (SUVmax 13-26) showed a recurrence rate of 25% with a median time to recurrence of 9 months (interquartile range 4-12). The second group showed an identical median time to recurrence of 9 months (IQR 6-22), the third group 18 months (IQR 8–30) and the lowest quartile group (SUVmax 0-2.4) had one recurrence at 13 months. Conclusion Our results suggest that preoperative FDG uptake may have a role in identifying patients who require more intensive postoperative cancer recurrence surveillance with CT in the first year. It remains to be established if this would be associated with a survival benefit. 1 Liu J, Dong M, Sun X, Li W, Xing L, Yu J. PLoS One . 2016; 11(1): e0146195.