Background: Although surgical resection remains the optimal treatment for early-stage NSCLC, up to 50% of patients with stage I and II relapse and die within 5 years after curative resection. Therefore prognostic markers are important as these patients might benefit from adjuvant therapy. The goal of this study was to evaluate established PET quantification metrics including: maximal standard uptake volume (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) as prognostic markers for early recurrence and overall survival in resected early stage lung cancer.

Methods: Between January 2003 and December 2010 182 surgically resected patients with stage I-II NSCLC who underwent 18 F FDG PET/CT less than one month prior to surgery have been evaluated. All patients had at least 5 years of follow-up. Cox proportional hazard model was used to determine the association between variables and survival respectively time to recurrence. For the multivariate analysis the following variables have been included: tumor size on CT, age tumor stage, histology, SUVmax, TLG (for TLG42% (threshold at 42% SUVmax) and TLG2.5 (cut-off at SUV 2.5) and MTV42% and MTV2.5).

Results: 133 patients were included, 71 with adeno carcinoma, 62 with squamous cell carcinoma. TLG2.5 and MTV2.5 values have been a significant prognostic factor for recurrence (P<0.0001). Patients with a MTV2.5 above 42 cm3 had a mean recurrence time of 0.8±0.9 years, while patients with MTV2.5 ≤ 42 cm3 recurred within 2.8±1.3 years. TLG2.5 and MTV2.5 PET volume metrics have not been predictable for overall survival in adenocarcinoma patients, recurrence or overall survival in squamous cell cancer. SUVmax, TLG42% and MTV42 were not predictable for early recurrence or survival for both histologies.

Conclusions: TLG2.5 and MTV2.5 may be useful prognostic variables in stage I-II NSCLC depending on the tumor type. Using a cut-off at 42 cm3 for early stage adenocarcinoma patients a high risk of recurrence within one year might be identified and adjuvant therapy following surgical resection could improve outcome for those patients.

Citation Format: Irene A. Burger, Michael Arvanitakis, Seraina Steiger, Walter Weder, Sven Hillinger. FDG PET quantification for prediction of early recurrence in patients with stage I and II non small cell lung cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2245.