Prognostic value of metabolic activity in noncancerous lung areas for stage I lung cancer - 12/04/26
, Hideyuki Furumoto, Yujin Kudo, Masaru Hagiwara, Masatoshi Kakihana, Tatsuo Ohira, Norihiko IkedaGraphical abstract |
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. |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Lung cancer, Idiopathic pulmonary fibrosis, PET-CT, SUVmax, Prognosis
Plan
Vol 89
Article 101267- mai 2026 Retour au numéro
Article précédent
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