Survival Prognostic Value of Morphological and Metabolic variables in Patients with Stage I and II Non-Small Cell Lung Cancer

Objectives The prognosis of patients with non-small cell lung cancer (NSCLC) is important as patients with resectable disease and poor prognostic variables might benefit from neoadjuvant therapy. The goal of the present study is to evaluate SUVmax, SUVmax ratio, CT volume, MTV and TLG as survival prognostic markers in patients with stage I-II NSCLC. In addition, we defined two variables; MTV x SUVmax and CT volume x SUVmax and assessed whether they can be used as prognostic markers.

Methods Between 2007-2012 patients with stage I-II NSCLC who had 18F FDG PET/CT exam and underwent surgery were evaluated. CT-based tumor volume and PET-based metabolic parameters were obtained. Cox proportional-hazard model was used to determine the association between the variables and survival. In addition, similar analysis was performed in cases with no lymph node (LN) involvement by the tumor.

Results 181 patients fulfilled the inclusion criteria. At the end of the study, 140 patients were alive and 41 did not survive with median survival of 41.3±18 and 25.6±19 months, respectively. SUVmax with a cut-off value of 8.2 was the only significant survival prognostic factor regardless of LN involvement (P= 0.012) (HR, 2.34; CI, 1.18-4.6). In cases with no LN involvement, SUVmax and CT volume (≥57ml) were a significant survival prognostic factors with (P=0.004 and 0.03) (HR, 2.75; CI, 1.35-5.6) and (HR, 2.2; with CI, 1.09-4.4), respectively.

Conclusions SUVmax may be a useful prognostic variable in stage I-II NSCLC while morphologic tumor volume might be useful in cases with no lymph node involvement.

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