Preoperative Maximum Standardized Uptake Value Associated With Recurrence Risk in Early Lung Cancer

This study aimed to investigate the maximum standardized uptake value (SUV_max) as a predictor of recurrence and timing of recurrence after resection of early-stage non-small cell lung cancer.

The study retrospectively reviewed patients from a single institution who underwent lobectomy for stage I to IIa non-small cell lung cancer from 2013 to 2018. Exclusion criteria included preoperative therapy and neuroendocrine histologic type. The study investigators collected recurrence and follow-up data, as well as preoperative SUV_max. A receiver operating characteristic curve was used to identify the optimal SUV_max for predicting recurrence. Kaplan-Meier curves and Cox regression analyses were used to identify predictors of freedom from recurrence (FFR).

The study included 238 patients, 30 (12.6%) of whom had disease recurrence. The receiver operating characteristic curve had an area under the curve of 0.671 and identified 4.93 as the optimal SUV_max cutoff. Patients were stratified into groups on the basis of this value; each group included 119 patients. High SUV_max was associated with larger tumor size, poor differentiation, lymphovascular invasion, and shorter FFR. The proportion of patients without recurrence at 5 years in the low- and high-SUV_max groups were 92.4% and 73.4%, respectively (P < .001). On univariate analysis, poor differentiation (hazard ratio [HR],2.35; 95% confidence interval [CI], 1.04 to 5.31; P = .04), lymphovascular invasion (HR, 3.19; 95% CI, 1.37 to 7.44; P = .007), visceral pleural invasion (HR, 2.33; 95% CI, 1.05 to 5.20; P = .04), and SUV_max 4.93 or greater (HR, 4.51; 95% CI, 1.84 to 11.03; P = .001) predicted FFR. On multivariable analysis, only SUV_max 4.93 or greater remained significant (HR, 5.36; 95% CI, 1.50 to 19.17; P = .01).

SUV_max is independently associated with a risk of recurrence after resection of early-stage lung cancer. SUV_max may be a valuable tool for stratifying patients with early-stage lung cancer for adjuvant therapy and surveillance frequency.