Whi Wonseok, Lee Hyunjong, Um Sang-Won, Kim Hong Kwan, Pyo Hong Ryul, Ahn Myung-Ju, Choi Joon Young
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11761-4.
This study aims to explore the prognostic value of primary tumor [F]fluorodeoxyglucose (FDG) uptake in non-small cell lung cancer (NSCLC) patients treated with curative therapy, particularly when considered alongside the new 9th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system.
A single-center retrospective study analyzed 3070 NSCLC patients who underwent pretherapeutic FDG PET/CT for initial staging. The survival analyses considered clinical variables, disease stage, and the primary tumor's maximum standardized uptake value (SUVmax). Univariate and multivariate analyses evaluated the prognostic significance of disease stage and SUVmax in predicting overall and disease-free survival. A new staging system incorporating SUVmax is proposed and compared with the conventional staging.
Two thousand nine hundred seventy-two patients (mean age, 64.5 ± 10.1 years; 1888 men) were evaluated. Primary tumor SUVmax was an independent prognostic factor in the univariate and multivariate analyses for overall and disease-free survival, alongside disease stages. Integrating SUVmax into the staging system improved prognostic stratification, especially in intermediate stages (stage IIA vs IIB, hazard ratio [HR] = 1.06, p = 0.72 for the conventional stage; HR = 1.27, p = 0.04 for the new proposed stage with SUVmax). Survival analyses revealed significant distinctions between reclassified groups based on SUVmax, highlighting its potential for risk assessment refinement.
The primary tumor SUVmax adds prognostic value to the 9th AJCC/UICC staging system for NSCLC. The proposed staging system incorporating SUVmax demonstrates enhanced prognostic accuracy compared with the conventional system.
Question The new NSCLC staging system does not incorporate tumor metabolism, which may enhance prognostic accuracy and improve risk stratification. Findings Primary tumor FDG uptake was an independent prognostic factor for survival in NSCLC. Its integration into staging improved risk stratification. Clinical relevance Primary tumor FDG uptake provides prognostic information in NSCLC. Its incorporation into staging improved risk classification, particularly in intermediate stages, allowing for more precise prognostication based on metabolic activity.
本研究旨在探讨在接受根治性治疗的非小细胞肺癌（NSCLC）患者中，原发性肿瘤[F]氟脱氧葡萄糖（FDG）摄取的预后价值，特别是与美国癌症联合委员会（AJCC）/国际癌症控制联盟（UICC）第9版新分期系统一起考虑时。
一项单中心回顾性研究分析了3070例接受治疗前FDG PET/CT进行初始分期的NSCLC患者。生存分析考虑了临床变量、疾病分期和原发性肿瘤的最大标准化摄取值（SUVmax）。单因素和多因素分析评估了疾病分期和SUVmax在预测总生存和无病生存方面的预后意义。提出了一种纳入SUVmax的新分期系统，并与传统分期进行比较。
评估了2972例患者（平均年龄64.5±10.1岁；1888例男性）。在单因素和多因素分析中，原发性肿瘤SUVmax与疾病分期一样，是总生存和无病生存的独立预后因素。将SUVmax纳入分期系统可改善预后分层，尤其是在中期（IIA期与IIB期，传统分期的危险比[HR]=1.06，p=0.72；纳入SUVmax的新提议分期的HR=1.27，p=0.04）。生存分析显示，基于SUVmax重新分类的组之间存在显著差异，突出了其在细化风险评估方面的潜力。
原发性肿瘤SUVmax为NSCLC的第9版AJCC/UICC分期系统增加了预后价值。与传统系统相比，纳入SUVmax的提议分期系统显示出更高的预后准确性。
问题新的NSCLC分期系统未纳入肿瘤代谢，而肿瘤代谢可能会提高预后准确性并改善风险分层。发现原发性肿瘤FDG摄取是NSCLC生存的独立预后因素。将其纳入分期可改善风险分层。临床意义原发性肿瘤FDG摄取为NSCLC提供预后信息。将其纳入分期可改善风险分类，尤其是在中期，从而能够根据代谢活性进行更精确的预后评估。
