Prognostic impact of maximum standardized uptake value on ¹⁸ F-FDG PET/CT imaging of the primary lung lesion on survival in advanced non-small cell lung cancer: A retrospective study

Background: Positron emission tomography/computed tomography (PET/CT) has been recognized for diagnosing and staging lung cancer, but the prognostic value of standardized uptake value (SUV) on ¹⁸ F-FDG PET/CT imaging in patients with advanced non-small cell lung cancer (NSCLC) remains controversial.

Methods: We performed a retrospective analysis of patients with advanced NSCLC who had undergone ¹⁸ F-FDG PET/CT before systemic treatment between June 2012 and June 2016. The relationship between the maximum SUV (SUVmax) of the pulmonary lesion and lesion size was evaluated via Spearman's correlation analysis. We collected patients' clinical and pathological data. Univariate and multivariate analyses were performed to analyze the factors influencing survival.

Results: We included 157 patients with advanced NSCLC. Among these, 135 died, 13 survived, and nine were lost to follow-up (median follow-up period, 69 months). SUVmax was correlated with lesion size and was significantly greater for tumors ≥3 cm than for tumors <3 cm (10.2 ± 5.4 vs. 5.6 ± 3.3, t = -6.709, p = 0.000). Univariate analysis showed that survival was associated with gender, tumor size, epidermal growth factor receptor gene mutation or anaplastic lymphoma kinase rearrangement, SUVmax of the primary lung lesion, and treatment lines. Multivariate analysis showed a significant correlation between SUVmax of the primary lung lesion and survival. The mortality risk of patients with SUVmax ≤6 was 35% lower than that of patients with SUVmax >6 (HR = 0.651, 95% confidence interval, 0.436-0.972; Wald value, 4.400; p = 0.036).

Conclusions: The SUVmax of the primary lung lesion on PET/CT is significantly correlated with survival in treatment-naive patients with advanced NSCLC.