FDG-PET SUVmax Combined with IASLC/ATS/ERS Histologic Classification Improves the Prognostic Stratification of Patients with Stage I Lung Adenocarcinoma

Background

We investigated the association between the newly proposed International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification and ¹⁸F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET), and whether the combination of these radiologic and pathologic factors can further prognostically stratify patients with stage I lung adenocarcinoma.

Methods

We retrospectively evaluated 222 patients with pathologic stage I lung adenocarcinoma who underwent FDG-PET scanning before undergoing surgical resection between 1999 and 2005. Patients were classified by histologic grade according to the IASLC/ATS/ERS classification (low, intermediate, or high grade) and by maximum standard uptake value (SUVmax) (low?<3.0, high???3.0). The cumulative incidence of recurrence (CIR) was used to estimate recurrence probabilities.

Results

Patients with high-grade histology had higher risk of recurrence (5-year CIR, 29?% [n?=?25]) than those with intermediate-grade (13?% [n?=?181]) or low-grade (11?% [n?=?16]) histology (p?=?0.046). High SUVmax was associated with high-grade histology (p?n?=?113] vs. 8?% [n?=?109]; p?=?0.013). Among patients with intermediate-grade histology, those with high SUVmax had higher risk of recurrence than those with low SUVmax (5-year CIR, 19?% [n?=?87] vs. 7?% [n?=?94]; p?=?0.033). SUVmax was associated with recurrence even after adjusting for pathologic stage (p?=?0.037).

Conclusions

SUVmax on FDG-PET correlates with the IASLC/ATS/ERS classification and can be used to stratify patients with intermediate-grade histology, the predominant histologic subtype, into two prognostic subsets.