Prognostic value of [18F]fluorodeoxyglucose PET/CT in the new staging system for non-small cell lung cancer

Objective This study aims to explore the prognostic value of primary tumor [F-18]fluorodeoxyglucose (FDG) uptake in non-small cell lung cancer (NSCLC) patients treated with curative therapy, particularly when considered alongside the new 9th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system. Materials and methods A single-center retrospective study analyzed 3070 NSCLC patients who underwent pretherapeutic FDG PET/CT for initial staging. The survival analyses considered clinical variables, disease stage, and the primary tumor's maximum standardized uptake value (SUVmax). Univariate and multivariate analyses evaluated the prognostic significance of disease stage and SUVmax in predicting overall and disease-free survival. A new staging system incorporating SUVmax is proposed and compared with the conventional staging. Results Two thousand nine hundred seventy-two patients (mean age, 64.5 +/- 10.1 years; 1888 men) were evaluated. Primary tumor SUVmax was an independent prognostic factor in the univariate and multivariate analyses for overall and disease-free survival, alongside disease stages. Integrating SUVmax into the staging system improved prognostic stratification, especially in intermediate stages (stage IIA vs IIB, hazard ratio [HR] = 1.06, p = 0.72 for the conventional stage; HR = 1.27, p = 0.04 for the new proposed stage with SUVmax). Survival analyses revealed significant distinctions between reclassified groups based on SUVmax, highlighting its potential for risk assessment refinement. Conclusions The primary tumor SUVmax adds prognostic value to the 9th AJCC/UICC staging system for NSCLC. The proposed staging system incorporating SUVmax demonstrates enhanced prognostic accuracy compared with the conventional system. Key Points Question The new NSCLC staging system does not incorporate tumor metabolism, which may enhance prognostic accuracy and improve risk stratification. Findings Primary tumor FDG uptake was an independent prognostic factor for survival in NSCLC. Its integration into staging improved risk stratification. Clinical relevance Primary tumor FDG uptake provides prognostic information in NSCLC. Its incorporation into staging improved risk classification, particularly in intermediate stages, allowing for more precise prognostication based on metabolic activity.