Maximum standardized uptake value significance in clinical stage IB–IIIB non-small cell lung cancer

Background: In recent years, the number of treatment options for locally advanced non-small cell lung cancer (NSCLC) has increased, including neoadjuvant therapy. Accurate preoperative evaluation of malignancy can assist in planning of therapeutic strategies for NSCLC. We evaluated whether the maximum standardized uptake value (SUVmax) could serve as a predictive prognostic factor for locally advanced clinical stage IB to IIIB NSCLC. Methods: We enrolled 396 patients with clinical stage IB-IIIB NSCLC who underwent lobectomy at the Kanagawa Cancer Center between January 2012 and December 2021. All patients underwent preoperative positron-emission tomography/computed tomography at our institution. The SUVmax cutoff value was determined using a receiver operating characteristic curve. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and were compared using log-rank tests. Factors associated with RFS and OS were determined using a Cox proportional hazards model. Results: Multivariate analysis demonstrated that the SUVmax of the primary tumor was independently associated with RFS and OS in clinical stage IB to IIIB NSCLC patients. SUVmax could stratify both the RFS and OS of patients, particularly from clinical stage IB to IIB. Furthermore, the rates of pathological upstaging and distant recurrence were higher in patients with resected clinical stage IB to IIIB NSCLC with a high SUVmax (>6.0) than in those with a low SUVmax (≤6.0). Conclusions: The SUVmax of the primary tumor is an important preoperative predictor of prognosis in clinical stage IB to IIIB NSCLC.