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Clinical implication and prognostic significance of standardised uptake value of primary non-small cell lung cancer on positron emission tomography: analysis of 176 cases

^a Department of Cardiothoracic Surgery, St. James's Hospital, Dublin 8, Ireland
^b Department of Thoracic Surgery, Chest Disease Hospital, Kuwait
^c Department of Nuclear Medicine, Blackrock Clinic, Dublin, Ireland

Received 6 March 2008; received in revised form 7 July 2008; accepted 14 July 2008.

^_* Corresponding author. Address: Department of Thoracic Surgery, Chest Disease Hospital, Al-Deya, P.O. Box 15179, 35452 Kuwait, Kuwait. Tel.: +965 6600543; fax: +965 4741504. (Email: trinityq8{at}hotmail.com).

Objective: We sought to assess the clinical implication and prognostic significance of maximum standardised uptake value (SUV_max) of primary non-small cell lung cancer (NSCLC) staged by integrated PET-CT. Methods: A retrospective review was carried out on 176 consecutive patients with histologically proven NSCLC who underwent staging with integrated PET-CT prior to curative intent surgical resection. SUV_max of primary NSCLC were measured and correlated with tumour characteristics, lymph node involvement, surgical stage, type of surgical resection and survival following resection. Results: SUV_max was significantly higher in centrally located tumours, tumours 4.0 cm, squamous cell subtype, poorly differentiated tumours, advanced T stage, advanced nodal stage, pleural invasion, and patients requiring complex surgical resection. SUV_max value of 15 was the best discriminative cut-off value for survival generated by log-rank test. When patients were stratified based on this value, those with SUV_max >15 were more likely to have centrally located tumours, squamous cell subtype, advanced T stage, advanced nodal stage, advanced American Joint Committee on Cancer (AJCC) stage, larger tumour size and required more advanced surgical resections than a simple lobectomy. Overall survival was significantly longer for patients with SUV_max 15 than those with SUV_max >15. Furthermore, nodal stage specific survival following resection (i.e. non-N2 and N2) were significantly better in patients with SUV_max 15 than SUV_max >15. Conclusion: SUV_max correlates with tumour characteristics, surgical stage and prognosis following resection. SUV_max may be a useful preoperative tool, in addition to other known prognostic markers, in allocating patients with potentially poor prognosis preoperatively to neoadjuvant chemotherapy prior to resection in order to improve their overall survival. Prospective and randomised trials are warranted.

Key Words: Positron emission tomography • Non-small cell lung cancer • Standardized uptake value • Survival