Does High Standard Uptake Value on Positron Emission Tomography Preclude Sublobar Resection in Stage IA Non-Small Cell Lung Cancer ≤2cm?

Background: Recent randomized trials have shown equivalent survival after sublobar resection (SLR) versus lobectomy in patients with clinical stage IA non-small cell lung cancer (NSCLC)≤2cm. High SUVmax is a known risk factor in NSCLC, yet limited data exists on whether a high SUV should preclude a SLR. This study aims to determine if there is an association between SUVmax and survival based on the extent of parenchymal resection.

Methods: A retrospective review of a prospectively maintained institutional database was conducted to identify patients with clinical stage IA NSCLC≤2cm (2011-2020) treated with SLR or lobectomy. The primary outcome was cancer-specific survival (CSS). Secondary outcomes were overall survival (OS) and disease-free survival (DFS).

Results: 543 patients were identified; 36.8% had SLR and 63.2% had lobectomy. Baseline characteristics were similar. Patients who had SLR had significantly worse ECOG performance status and higher rates of comorbidities. 5-year CSS, OS, and DFS for the whole cohort were similar between SLR and lobectomy. A receiver operating characteristic curve estimated the SUVmax cutoff point to be 4.15. For the whole cohort, patients with SUVmax>4.15 had worse CSS compared to SUVmax≤4.15. However, there was no significant difference in 5-year CSS after SLR versus lobectomy in patients with SUVmax≤4.15 (98% in both groups; P=0.77) or patients with SUVmax>4.15 (90% versus 94% respectively; P=0.12).

Conclusions: SUVmax may not be a useful clinical determinant of the extent of parenchymal resection in patients with cT1N0 NSCLC≤2cm. Patients treated by SLR had comparable survival to lobectomy, irrespective of PET avidity.