Annals of Nuclear Medicine

, Volume 32, Issue 10, pp 687–694 | Cite as

The value of different 18F-FDG PET/CT baseline parameters in risk stratification of stage I surgical NSCLC patients

  • Hoda Anwar
  • Thomas J. Vogl
  • Mahasen A. Abougabal
  • Frank Grünwald
  • Peter Kleine
  • Sherif Elrefaie
  • Nour-Eldin A. Nour-Eldin
Original Article



Administration of postoperative chemotherapy to patients with completely resected stage I NSCLC is still a matter of debate. The aim of the present study was to evaluate the value of different baseline 18F-FDG PET parameters in identifying surgical stage I NSCLC patients who are at high risk of recurrence, and thus are indicated for further postoperative treatment.


This is a retrospective study, which included 49 patients (28 males, 21 females) with the median age of 69 years (range 28–84), who had pathologically proven stage I NSCLC. All patients underwent 18F-FDG PET/CT at baseline followed by complete surgical resection of the tumor (R0). Baseline SUVmax, MTV and TLG were measured. Patients’ follow-up records were retrospectively reviewed, and DFS (disease-free survival) was assessed. For each parameter, the most accurate cut-off value for the prediction of recurrence was calculated using the ROC curve analysis and the Youden index. DFS was evaluated for patients above and below the calculated cut-off value using the Kaplan–Meier method and the difference in survival between the two groups was estimated using the log-rank test.


Median observation time of the patients after surgery was 28.7 months (range 3.5–58.8 months). 9 patients developed recurrence. The calculated cut-off values for SUVmax, MTV and TLG were 6, 6.6 and 33.6, respectively. Using these cut-offs, the observed sensitivity for SUVmax, MTV and TLG for prediction of recurrence was 100%, 89% and 89%, respectively, while the observed specificity was 43%, 73% and 65%, respectively. The difference in survival between patients below and above the cut-off value was statistically significant in all three studied parameters. The highest AUC was observed for MTV (AUC = 0.825, p = 0.003), followed by TLG (AUC = 0.789, p = 0.007), and lastly SUVmax (AUC = 0.719, p = 0.041). ROC curve analysis showed that volumetric parameters had better predictive performance than SUVmax as regards recurrence.


PET-derived parameters at baseline were predictive of recurrence in stage I surgical NSCLC patients. Moreover, the metabolic volume of the tumor was the most significant parameter for this purpose among the studied indices.




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Japanese Society of Nuclear Medicine 2018

Authors and Affiliations

  1. 1.Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear MedicineFaculty of Medicine-Cairo UniversityCairoEgypt
  2. 2.Institute for Diagnostic and Interventional RadiologyJohann Wolfgang von Goethe University HospitalFrankfurt am MainGermany
  3. 3.Department of Nuclear MedicineJohann Wolfgang von Goethe University HospitalFrankfurt am MainGermany
  4. 4.Department of Cardiothoracic SurgeryJohann Wolfgang von Goethe University HospitalFrankfurt am MainGermany
  5. 5.Department of Diagnostic and Interventional RadiologyCairo University HospitalCairoEgypt

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