Prognostic value of FDG uptake in early stage non-small cell lung cancer

Background: Non-small cell lung cancer (NSCLC) has a poor prognosis even for early stages of the disease (stage I and II). We studied the prognostic value of PET FDG in patients with completely resected stage I and II NSCLC. Methods: Retrospective study of 96 patients with NSCLC whose staging included F-18-FDG PET (fluoro deoxy glucose positron emission tomography). Histopathotogicat stage was either stage I (75) or stage II (n = 21). FDG uptake was measured as maximal. standardized uptake value for body weight (SUVmax). Mean follow-up was 45 30 months (1 142 months). Overall and cancer-free survival rates were recorded. Results: SUVmax were higher for stage II than for stage I (10.5 +/- 4.5 vs 8.5 +/- 5, p = 0.04). Mean umor volumes were equivalent for both stages (33 cm(3), p = 0.18), excluding a partial volume effect. The median SUVmax in the whole study population was 7.8. The median survival was significantly longer in patients with a tower (SUVmax <= 7.8) FDG uptake (127 months vs 69 months, p = 0.001). For stage I tumors (n = 75), high FDG uptake was significantly associated with reduced median survival: 127 months if SUVmax <= 7.8 and 69 months if SUVmax > 7.8 (p = 0.001). For stage II tumors In = 21), no statistical difference was observed: 72 months vs 40 months for SUVmax <= 7.8 and for SUVmax > 7.8, respectively (p = 0.11), although there was a clear trend towards reduced survival for highly metabolic tumors. Disease-free survival was also significantly better for tower metabolic tumors: 96.1 months vs 87.7 months (p = 0.01). Conclusion: High FDG uptake is associated with reduced overall survival and disease-free survival of patients with completely resected stage I-II NSCLC. Whether patients with highly metabolic tumors should undergo a closer postoperative surveillance or adjuvant chemotherapy has to be addressed in a property designed prospective trial. (0 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.