title: Sex and SUVmax: sex-dependent prognostication in early non-small cell lung cancer.
abstract: The identification of robust prognostic factors for patients with early-stage non-small cell lung cancer (NSCLC) is clinically important. The International Association for the Study of Lung Cancer has identified both sex and the maximum standardized uptake value (SUVmax) of (18)F-FDG in the primary tumor as measured by PET as potential prognostic variables. We examined the prognostic value of SUVmax in a surgical cohort of patients with NSCLC and disaggregated the findings by sex.
  
  
  METHODS
  Patients who had undergone a preoperative PET/CT scan and surgical resection with curative intent from 2001 to 2009 were identified from a prospective database. An SUVmax cutoff was calculated using receiver-operating-characteristic curves. Overall survival was correlated with SUVmax for the whole cohort and disaggregated by sex.
  
  
  RESULTS
  Inclusion criteria were met by 189 patients: 127 (67%) men and 62 (33%) women. Five-year survival was 54.6% for the whole cohort, 47.7% for men, and 68.2% for women. SUVmax correlated negatively with survival in a univariate analysis for the whole cohort (hazard ratio [HR], 2.51; 95% confidence interval [CI], 1.54-4.09; P < 0.001) and men (HR, 3.42; 95% CI, 1.94-6.05; P < 0.001) but not for women (HR, 1.61; 95% CI, 0.43-3.12; P = 0.77), using 8 as a cutoff. In multivariate analysis, SUVmax correlated with overall survival for the whole cohort (HR, 1.70; 95% CI, 1.05-2.99; P = 0.05) and men (HR, 2.40; 95% CI, 1.32-4.37; P = 0.004) but not for women (HR, 0.80; 95% CI, 0.15-4.47; P = 0.80).
  
  
  CONCLUSIONS
  SUVmax independently predicted overall survival for men but not for women in this surgical cohort. Our results suggest that SUVmax is an independent prognostic variable in men with surgically treated early NSCLC.
authors.affiliation: Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia. zoewainer@gmail.com
authors.forename: Zoe
authors.initials: Z
authors.lastname: Wainer
authors.forename: Marissa G
authors.initials: MG
authors.lastname: Daniels
authors.forename: Jason
authors.initials: J
authors.lastname: Callahan
authors.forename: David
authors.initials: D
authors.lastname: Binns
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
authors.forename: Phillip
authors.initials: P
authors.lastname: Antippa
authors.forename: Prudence A
authors.initials: PA
authors.lastname: Russell
authors.forename: Naveed Z
authors.initials: NZ
authors.lastname: Alam
authors.forename: Matthew
authors.initials: M
authors.lastname: Conron
authors.forename: Benjamin
authors.initials: B
authors.lastname: Solomon
authors.forename: Gavin M
authors.initials: GM
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D015992:Body Mass Index; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012727:Sex Characteristics; D013997:Time Factors; D014057:Tomography, X-Ray Computed