The prognostic value of PET/CT-derived volumetric parameters for postoperative recurrence in resected non-small cell lung cancer

Abstract

Aims: Non-small-cell lung cancer (NSCLC) recurrence is high even after complete surgical resection. This study aimed to investigate the relationship between recurrence and 18F-fluorodeoxyglucose positron emission tomography computed tomography parameters and to determine prognostic factors. Methods: Stage I–II NSCLC, confirmed through pathology after undergoing surgical resection were retrospective analyzed. Before surgery, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were derived by applying SUVmax-based thresholds of 2.5 and 42%. Data regarding demographics, clinicopathological features, and tumor characteristics were gathered. Kaplan–Meier method was used for disease-free survival (DFS) and overall survival rates. Prognostic factors causing recurrence were evaluated using univariate and multivariate Cox regression analysis. Results: The average age of the 179 people included in the study was 61.24 years. Median follow up time was 50 months. Recurrence occurred in 38.5% of the patients. Prognostic factors for recurrence were larger tumor size, visceral pleural invasion, and PL2 involvement. When stratified by histology, MTV measured using SUVmax thresholds of 2.5 and 42% was significantly higher in patients with recurrence in the squamous cell carcinoma subgroup. In univariate analysis, high MTV42% was associated with shorter DFS. In multivariate analysis, MTV2.5 remained an independent predictor of DFS. SUVmax and TLG were not independently associated with DFS. Conclusion: Disease-free survival was influenced by tumor size and the presence of pleural invasion. MTV may serve as a complementary prognostic biomarker to TNM staging in patients with early-stage NSCLC.