Impact of High SUVmax on Recurrence by Resection Strategy in Stage IA Adenocarcinoma ≤2 cm.

Abstract

High maximum standard uptake value (SUVmax) is associated with recurrence after non-small cell lung cancer resection, but whether it should affect the decision between lobectomy and sublobar resection for stage IA adenocarcinoma ≤2 cm is unclear. This study examined the value of SUVmax in guiding resection strategy. This study was a retrospective single-center review (2005-2024) of patients with clinical stage IA adenocarcinoma ≤2 cm with preoperative positron emission tomography who underwent lobectomy or sublobar resection. The optimal SUVmax threshold for recurrence-free survival was identified using maximally selected rank statistics and was used to categorize patients into high- and low-standard uptake value (SUV) groups. Primary outcomes were recurrence and disease-free survival (DFS); secondary outcomes were overall survival and cancer-specific survival. Among 558 patients (309 who underwent lobectomy; 249 who had sublobar resection), recurrence occurred in 28 (9.1%) and 34 (13.7%), respectively. The optimal SUVmax cutoff was 3.0. On multivariate analysis, high SUVmax was an independent predictor of recurrence in both the entire cohort (odds ratio [OR], 2.29; 95% CI, 1.17-4.50; P = .02) and the sublobar resection group (OR, 3.16; 95% CI, 1.19-8.44; P = .02). Among patients who underwent wedge resections alone, high SUV remained an independent predictor of disease recurrence (OR, 4.18; 95% CI, 1.44-12.48; P = .01]. In the high-SUV group, DFS was inferior after sublobar vs lobar resection (62.5% vs 78.7%; P = .022), whereas no DFS difference was seen between procedures among low-SUV patients. Overall survival and cancer-specific survival did not differ by strategy within either SUV category. SUVmax ≥3 independently predicted recurrence after sublobar resection, with findings driven primarily by the wedge resection subgroup. This result suggests careful consideration of resection strategy, particularly wedge resection, for stage 1A tumors with SUVmax ≥3.