Prognostic value of metabolic activity in noncancerous lung areas for stage I lung cancer - 29/03/26

Doi : 10.1016/j.resmer.2026.101267

Takashi Yamamichi ^a, Yoshihisa Shimada ^a,^⁎ , Hideyuki Furumoto ^a, Yujin Kudo ^a, Masaru Hagiwara ^a, Masatoshi Kakihana ^a, Tatsuo Ohira ^a, Norihiko Ikeda ^a

^a Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan

^⁎ Corresponding Author: Yoshihisa Shimada, M.D., Ph.D., Department of Surgery, Tokyo Medical University6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; Phone: +81-(0)3-3342-6111, Fax: +81-(0)3-3342-6203. Department of Surgery Tokyo Medical University6-7-1 Nishishinjuku Shinjuku-ku Tokyo 160-0023 Japan

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Highlights

•	Background lung SUVmax on PET/CT predicts survival in stage I lung cancer
•	High background lung SUVmax (≥1.34) independently predicts poor survival
•	Combined high background lung SUVmax and IPF shows markedly poor survival outcomes
•	Background lung SUVmax is independent of tumor SUVmax as a prognostic marker
•	This parameter requires no additional imaging cost beyond routine PET/CT

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Abstract

Background

Tumor maximum standardized uptake value (tumor-SUVmax) on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is an established prognostic marker in lung cancer. However, metabolic activity of the background lung parenchyma has received little attention. Idiopathic pulmonary fibrosis (IPF) significantly worsens lung cancer prognosis; however, CT assessments have limitations in predicting outcomes. We investigated whether measuring SUVmax in noncancerous lung areas (NCA-SUVmax) could capture subclinical inflammatory activity and provide additional prognostic information.

Methods

We retrospectively analyzed 616 patients with pathological stage I lung cancer, who had undergone surgical resection between 2012 and 2019. Both tumor-SUVmax and NCA-SUVmax were measured using preoperative FDG PET/CT. Receiver operating characteristic analysis revealed optimal NCA-SUVmax cutoff values. Survival outcomes between high (≥1.34) and low (<1.34) NCA-SUVmax groups were compared using Kaplan–Meier analysis and Cox regression models.

Results

During a median follow-up of 60 months, 56 patients (9.1%) experienced recurrence and 89 (14.4%) died. Tumor-SUVmax and NCA-SUVmax showed weak correlations, independently predicting survival. Patients with high NCA-SUVmax (n=162, 26.3%) had significantly worse 5-year disease-free (72.2% vs. 91.7%) and overall survival (77.2% vs. 93.1%). IPF prevalence was markedly higher in the high NCA-SUVmax group (29.6% vs. 2.9%). Multivariate analysis identified tumor-SUVmax and NCA-SUVmax as independent predictors (hazard ratios: 1.60 and 1.56). Patients with high NCA-SUVmax and IPF demonstrated particularly inferior outcomes (5-year survival: 52.0% disease-free, 52.4% overall).

Conclusions

NCA-SUVmax provides independent prognostic information beyond conventional tumor-SUVmax for identifying high-risk patients with concurrent IPF. This parameter may improve risk stratification in patients with Stage I lung cancer.

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