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

Background

Recent randomized trials have shown equivalent survival after sublobar resection vs lobectomy in patients with clinical stage IA non-small cell lung cancer (NSCLC) ≤2 cm. High maximum standard uptake value (SUVmax) is a known risk factor in NSCLC, yet limited data exist on whether a high SUV should preclude a sublobar resection. This study aimed to determine whether 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 ≤2 cm (2011-2020) treated with sublobar resection or lobectomy. The primary outcome was cancer-specific survival (CSS). Secondary outcomes were overall survival and disease-free survival.

Results

There were 543 patients identified; 36.8% had sublobar resection and 63.2% had lobectomy. Baseline characteristics were similar. Patients who had sublobar resection had significantly worse Eastern Cooperative Oncology Group performance status and higher rates of comorbidities. The 5-year CSS, overall survival, and disease-free survival for the whole cohort were similar between sublobar resection 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 with SUVmax ≤4.15. However, there was no significant difference in 5-year CSS after sublobar resection vs lobectomy in patients with SUVmax ≤4.15 (98% in both groups; P = .77) or patients with SUVmax >4.15 (90% vs 94%, respectively; P = .12).

Conclusions

SUVmax may not be a useful clinical determinant of the extent of parenchymal resection in patients with cT1 N0 NSCLC ≤2 cm. Patients treated by sublobar resection had comparable survival to lobectomy, irrespective of positron emission tomography avidity.