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Original Research: LUNG CANCER |

PET Scan 18F-Fluorodeoxyglucose Uptake and Prognosis in Patients With Resected Clinical Stage IA Non-small Cell Lung Cancer

Viswam S. Nair, MD; Paul G. Barnett, PhD; Lakshmi Ananth, MS; Michael K. Gould, MD, MS, FCCP; for the Veterans Affairs Solitary Nodule Accuracy Project Cooperative Studies Group
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Nair and Gould), Stanford University School of Medicine, and the Department of Health Research and Policy (Drs Barnett and Gould), Stanford University, Stanford; the Health Economics Resource Center (Dr Barnett and Ms Ananth), VA Palo Alto Health Care System, Menlo Park; and the VA Palo Alto Health Care System (Dr Gould), Palo Alto, CA.

Correspondence to: Viswam S. Nair, MD, Stanford University School of Medicine, Division of Pulmonary and Critical Care Medicine, 300 Pasteur Dr, A283, Stanford, CA 94305; e-mail: viswamnair@stanford.edu


Funding/Support: This study was supported by the VA Cooperative Studies Program, Office of Research and Development (VA Cooperative Study 027).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1150-1156. doi:10.1378/chest.09-2356
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Objective:  Our objective was to examine the association between 18F-fluorodeoxyglucose (FDG) uptake on PET scan and prognosis in patients with surgically treated, clinical stage IA non-small cell lung cancer (NSCLC).

Methods:  We reviewed data collection forms and Veterans Affairs administrative records of 75 patients with surgically treated, stage IA NSCLC who were enrolled in a prospective study of PET imaging from 1999 to 2001. We used Cox proportional hazards analysis to examine the association between FDG uptake and survival 4 years following enrollment.

Results:  Most patients were men (97%), and the mean age was 68 ± 9 years. Almost half of the patients (44%) had adenocarcinoma, and 35% underwent a sublobar resection. The mean maximum standardized uptake value (SUVmax) was 4.9 ± 2.5 in survivors and 7.1 ± 3.9 in nonsurvivors (P = .045). Before and after adjustment for age, tumor size, histology, and type of resection, the hazard of death was significantly higher in patients with squamous cell histology (adjusted hazard ratio [HR], 4.54; 95% CI, 1.09-18.9) and those with higher degrees of FDG uptake (adjusted HR, 1.21 per 1 unit increment; 95% CI, 1.01-1.45). At a threshold value of 5 for SUVmax, 34 of 39 patients (87%) with low FDG uptake survived, compared with only 24 of 36 patients (67%) with high FDG uptake (P = .04). Visual assessment of FDG uptake was not associated with an increased hazard of death (HR 0.66; 95% CI, 0.19-2.29).

Conclusions:  High FDG uptake as measured by SUVmax identifies individuals with clinical stage IA NSCLC who are at increased risk of death following surgery. Such high-risk patients may be good candidates for participation in future trials of adjuvant therapy.

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