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J Thorac Cardiovasc Surg 2007;133:1419-1427
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Fluorine-18 fluorodeoxyglucose positron emission tomographic maximal standardized uptake value predicts survival independent of clinical but not pathologic TNM staging of resected non–small cell lung cancer

Robert J. Downey, MDa,*, Timothy Akhurst, MBBS, FRACPb, Mithat Gonen, PhDc, Bernard Parka, Valerie Rusch, MDa

a Thoracic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
b Division of Nuclear Medicine, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
c Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication June 29, 2006; revisions received December 6, 2006; accepted for publication January 8, 2007.

* Address for reprints: Robert J. Downey, MD, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021. (Email: downeyr{at}mskcc.org).

Objectives: Positron emission tomographic maximal standardized uptake value has been shown to predict survival after resection of non–small cell lung cancer. The relative prognostic benefit of maximal standardized uptake value with respect to other clinical/pathologic variables has not been defined.

Methods: We reviewed patients who had positron emission tomographic imaging and an R0 resection for non–small cell lung cancer between January 1, 2000, and December 31, 2004, without induction or adjuvant therapy. The associations between overall survival, histology, pathologic TNM stage, pathologic tumor diameter, and standardized uptake value were tested.

Results: Four hundred eighty-seven patients met the study criteria. Median follow-up was 25.8 months. By using the median values for tumor size (2.5 cm) and standardized uptake value (5.3), standardized uptake value was an independent predictor of survival (P = .03), adjusting for tumor size (P = .02) and histology (P < .01). The optimal standardized uptake value for stratification was identified as 4.4, and this value was identified as an independent predictor of survival (P = .03) after adjusting for clinical TNM stage. Standardized uptake value was not an independent predictor of survival (P = .09), adjusting for pathologic TNM stage (stage IA vs IB vs stage II–IV, P < .01).

Conclusions: Standardized uptake value does not add to the prognostic significance of pathologic TNM stage. Standardized uptake value was an independent prognostic factor from clinical TNM stage.

Abbreviations and Acronyms CT = computed tomography; 18F-FDG = fluorine-18 fluorodeoxyglucose; NSCLC = non–small cell lung cancer; pTNM = pathologic TNM; SUV = standardized uptake value; SUVMAX = maximal standardized uptake value


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Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 1425-1427. [Extract] [Full Text] [PDF]



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