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

Abstract

Background: This study aimed to investigate the maximum standardized uptake value (SUVmax) as a predictor of recurrence and timing of recurrence after resection of early-stage non-small cell lung cancer. Methods: 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 SUVmax. A receiver operating characteristic curve was used to identify the optimal SUVmax for predicting recurrence. Kaplan-Meier curves and Cox regression analyses were used to identify predictors of freedom from recurrence (FFR). Results: 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 SUVmax cutoff. Patients were stratified into groups on the basis of this value; each group included 119 patients. High SUVmax 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-SUVmax 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 SUVmax 4.93 or greater (HR, 4.51; 95% CI, 1.84 to 11.03; P = .001) predicted FFR. On multivariable analysis, only SUVmax 4.93 or greater remained significant (HR, 5.36; 95% CI, 1.50 to 19.17; P = .01). Conclusions: SUVmax is independently associated with a risk of recurrence after resection of early-stage lung cancer. SUVmax may be a valuable tool for stratifying patients with early-stage lung cancer for adjuvant therapy and surveillance frequency.