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 18F-FDG PET (fluoro deoxy glucose positron emission tomography). Histopathological 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 tumor volumes were equivalent for both stages (33 cm3, 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 lower (SUVmax<or=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<or=7.8 and 69 months if SUVmax>7.8 (p=0.001). For stage II tumors (n=21), no statistical difference was observed: 72 months vs 40 months for SUVmax<or=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 lower metabolic tumors: 96.1 months vs 87.7 months (p=0.01).


CONCLUSIONS
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 properly designed prospective trial.
Hanin
François-Xavier
FX
Department of Nuclear Medicine, UCL Saint-Luc Hospital, Brussels, Belgium.
Lonneux
Max
M
Cornet
Julien
J
Noirhomme
Philippe
P
Coulon
Corinne
C
Distexhe
Julien
J
Poncelet
Alain J
AJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000378:metabolism*; D012189:Retrospective Studies; D015996:Survival Rate
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18