Suvmax of the lesion should be considered in the treatment plan for stage I non-small cell lung cancer.

Objectives: High maximum standardized uptake value (SUVmax) is associated with poorly differentiated tumors and lymph node metastasis. It is still controversial which tumors can be treated with sublobar resection and there are publications stating that SUVmax of the tumor may be important in choosing sublobar resection. Our aim in this study is to examine the prognostic value of tumor SUVmax in stage 1 non-small cell lung cancer and to determine its place in sublobar resection preference.

Methods: The study included 314 patients who underwent wedge resection, segmentectomy or lobectomy for pathological stage I NSCLC with tumor size ≤ 3 cm between January 2008 and December 2020. SUVmax of the tumors are dichotomized according to ROC threshold value 5.2 and prognostic factors for recurrence-free and overall survival were analysed.

Results: In the multivariate survival analysis, SUVmax (p = 0.012), lymphovascular and/or perineural invasion (p < 0.001) and visceral pleural invasion (p = 0.031) were found to be independent prognostic factors for recurrence-free survival; age (p = 0.027), sex (p = 0.010) and SUVmax (p = 0.036) for overall survival. While there was no difference between lobar or sublobar resection in terms of recurrence-free survival (p = 0.647) in patients with SUVmax ≤ 5.2, lobectomy was found to be advantageous over sublobar resection for recurrence-free survival in patients with SUVmax > 5.2 (76.6% ± 3.9% / 53.4% ± 12.1%, p = 0.006, respectively).

Conclusions: High SUVmax (> 5.2) is associated with poor recurrence-free survival and overall survival rates in pathological stage 1 NSCLC patients. In stage 1 patients, sublobar resection should be avoided if the primary tumor has a high SUVmax.