Maximum standardized uptake (SUVmax) is associated with pathologically upstaged and recurrence-free survival in...

Timely detection of early-stage lung cancer via screening programs has improved, but unexpected advanced disease might exist and influence the prognosis. This study aimed to investigate the association between positron emission tomography (PET) maximum standardized uptake (SUVmax) and pathological upstaging and survival in patients with clinical stage IA (T1N0M0) non-small cell lung cancer (NSCLC).

We retrospectively reviewed patients with clinical stage IA NSCLC who underwent preoperative PET scans and curative surgery at Kaohsiung Veterans General Hospital from January 2015 to December 2021. The primary outcome was the rate of pathological upstaging, and a Cox regression model was used to identify prognostic factors for recurrence-free survival (RFS).

In total, 112 cases were included in this analysis, with a median observation time of 71.7 months. Forty-three patients (38.4%) were pathologically upstaged, and the pathologically upstaged group had a significantly higher SUVmax than the non-upstaged group (p = 0.024). Cox regression demonstrated that a SUVmax ≥ 5 was a significant independent prognostic factor for RFS (hazard ratio 6.698, 95% CI: 2.031-22.084, p < 0.001). In addition, there was a significant difference in the median RFS between the SUVmax ≥ 5 and SUVmax < 5 groups (48.1 versus 77.4 months, p < 0.001).

Elevated preoperative PET SUVmax is associated with increased pathological upstaging, as well as a poorer RFS in clinical stage IA NSCLC. Although a PET SUVmax ≥ 5 was identified as a strong independent prognostic indicator of RFS in our cohort, this threshold should be interpreted cautiously.