Prognostic importance of the standardized uptake value on F-18-fluoro-2-deoxy-glucose-positron emission tomography scan in non-small-cell lung cancer: An analysis of 125 cases

Purpose: The amount of radio-labeled F-18-fluoro-2-deoxy-glucose (FDG) upta ke, a measurement of the increased glucose metabolism of non-small cell lun g cancer (NSCLC) cells, has recently been correlated with proliferation cap acity. The Standardized Uptake Value (SUV), a semi-quantitative measurement of FDG uptake on positron emission tomography (PET) scan, could thus be of prognostic significance. Patients and Methods: We analyzed the follow-up of 125 potentially operable NSCLC patients, previously included in three of our prospective PET protoc ols. Performance status, maximal tumor diameter, tumor-cell type, SUV, and final staging were analyzed for their possible association with survival. Results: Sixty-five patients had stage I or II NSCLC, 37 had stage IIIA, an d 23 had stage IIIB. Treatment was complete resection in 91 cases. In a uni variate analysis, performance status (P = .002), stage (P = .001), tumor di ameter (P = .06), tumor-cell type (P = .03), and SUV greater than 7 (P = .0 01) were correlated with survival. For SUV, group dichotomy with a cut-off SUV of 7 had the best discriminative value for prognosis, both in the total and surgical cohort. A multivariate Cox analysis identified performance st atus (P = .02), stage (P = .01), and SUV (P = .007) as important for the pr ognosis. In the surgical group, patients with a resected tumor less than 3 cm had an expected 2-year survival of 86%, if the SUV was below 7, and 60%, if above 7. Nearly all resected tumors larger than 3 cm hard SUV's greater than 7 and an expected 2-year survival of 43%. Conclusion: We conclude that the FDG uptake in primary NSCLC on PET has an important prognostic value and could be complementary to other well-known f actors in the decision on adjuvant treatment protocols. (C) 1999 by America n Society of Clinical Oncology.