The Prognostic Significance of Maximum Standardized Uptake Value of Primary Tumor in Surgically Treated Non-Small-Cell Lung Cancer Patients: Analysis of 413 Cases

We assessed the prognostic significance of tumor maximum standardized uptake value (SUVmax) at positron emission tomography and computed tomography (PET/CT) in surgically resected lung cancer patients and whether a novel standardized SUV ratio of tumor SUVmax to liver or blood pool SUVmax was additionally prognostically significant in 413 patients. Tumor SUVmax was an independent prognostic factor but both ratios were not. Our results could help plan adjuvant treatment. Background: Integrated PET/CT is widely used in the preoperative staging and prognostic assessment of non-small-cell lung cancer (NSCLC) patients. The aims of this study were to evaluate the prognostic significance of SUVmax of primary tumor in patients undergoing surgical treatment and, in order to minimize technical interferences, to verify whether SUVmax standardized by SUVmax liver or SUVmax blood pool provided additional prognostic information. Patients and Methods: A retrospective study of 413 consecutive NSCLC patients undergoing potentially curative surgical resection after PET/CT obtained in the same PET center over a 6-year period. The SUVmax was calculated drawing region of interest around the primitive tumor, the liver, and the aortic arch in PET images. The same procedure was performed for 2 adjacent planes and the average of these measures was considered. Results: Nine patients were considered 30-day postoperative deaths and were excluded from the analysis. At the end of the study, 312 (77.2%) of the 404 patients were alive (median follow-up, 26 months) and 92 had died (median survival, 17 months). At multivariate analysis tumor-node-metastasis stage, primary tumor grading and primary tumor SUVmax (T-SUVmax) were found to be independent prognostic factors, while T-SUVmax/SUVmax blood pool ratio, and T-SUVmax/SUVmax liver ratio were not. Conclusions: T-SUVmax is an independent predictor for survival in NSCLC patients undergoing surgery and might be helpful in guiding adjuvant treatment strategies. SUVmax of primary tumor normalized by SUV blood pool or SUV liver does not provide additional prognostic information. Clinical Lung Cancer, Vol. 14, No. 2, 149-56 (c) 2013 Elsevier Inc. All rights reserved.