New positron emission tomography derived parameters as predictive factors for recurrence in resected stage I non-small cell lung cancer

Eur J Surg Oncol. 2013 Nov;39(11):1254-61. doi: 10.1016/j.ejso.2013.07.092. Epub 2013 Aug 13.


Background: The recurrence rate for stage I non-small cell lung cancer is high, with 20-40% of patients that relapse after surgery. The aim of this study was to evaluate new F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) derived parameters, such as standardized uptake value index (SUVindex), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as predictive factors for recurrence in resected stage I non-small cell lung cancer.

Methods: We retrospectively reviewed 99 resected stage I non-small cell lung cancer patients that were grouped by SUVindex, TLG and MTV above or below their median value. Disease free survival was evaluated as primary end point.

Results: The 5-year overall survival and the 5-year disease free survival rates were 62% and 73%, respectively. The median SUVindex, MTL and TLG were 2.73, 2.95 and 9.61, respectively. Patients with low SUVindex, MTV and TLG were more likely to have smaller tumors (p ≤ 0.001). Univariate analysis demonstrated that SUVindex (p = 0.027), MTV (p = 0.014) and TLG (p = 0.006) were significantly related to recurrence showing a better predictive performance than SUVmax (p = 0.031). The 5-year disease free survival rates in patients with low and high SUVindex, MTV and TLG were 84% and 59%, 86% and 62% and 88% and 60%, respectively. The multivariate analysis showed that only TLG was an independent prognostic factor (p = 0.014) with a hazard ratio of 4.782.

Conclusion: Of the three PET-derived parameters evaluated, TLG seems to be the most accurate in stratifying surgically treated stage I non-small cell lung cancer patients according to their risk of recurrence.

Keywords: Imaging; Non-small cell lung cancer; PET; Prognosis; Surgery.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging
  • Carcinoma, Non-Small-Cell Lung / metabolism*
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Female
  • Fluorodeoxyglucose F18 / metabolism
  • Glycolysis*
  • Humans
  • Kaplan-Meier Estimate
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / metabolism*
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / metabolism
  • Neoplasm Staging
  • Odds Ratio
  • Positron-Emission Tomography* / methods
  • Predictive Value of Tests
  • Prognosis
  • Radiopharmaceuticals / metabolism
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Tomography, X-Ray Computed


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18