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

Authors

Jacob Guorgui, Jeremiah Hutson, Devanish Kamtam, Jake Jungmin Kim, Irmina Elliott, Natalie Lui, Douglas Liou, Brandon Guenthart, Leah Backhus, Mark Berry, Joseph Shrager

Published in

The Annals of thoracic surgery. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

High maximum standard uptake value (SUVmax) is associated with recurrence after NSCLC resection, but whether it should impact the lobectomy vs. sublobar decision for Stage IA adenocarcinoma ≤2cm is unclear. We examined the value of SUVmax in guiding resection strategy.
Retrospective single-center review (2005-2024) of clinical Stage IA adenocarcinoma ≤2cm with preoperative PET who underwent lobectomy or sublobar resection. The optimal SUVmax threshold for recurrence-free survival was identified using maximally-selected rank statistics and used to categorize patients into high and low SUV groups. Primary outcomes were recurrence and disease-free survival (DFS); secondary outcomes were overall (OS) and cancer-specific survival (CSS).
Among 558 patients (309 lobectomy; 249 sublobar), recurrence occurred in 28 (9.1%) and 34 (13.7%), respectively. The optimal SUVmax cut-off was 3.0. On multivariate analysis, high SUVmax was an independent predictor of recurrence in both the entire cohort [OR: 2.29 (1.17-4.50), p=0.02] and the sublobar group [OR: 3.16 (1.19-8.44), p=0.02]. Among wedge resections alone, high SUV remained an independent predictor of recurrence [OR: 4.18 (1.44-12.48); p=0.01]. In the high SUV group, DFS was inferior after sublobar vs lobar resection (62.5% vs 78.7%; p=0.022), while no DFS difference was seen between procedures among low SUV patients. OS and CSS 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 suggests careful consideration of resection strategy, particularly wedge resection, for Stage 1A tumors with SUVmax ≥3.

PMID:
42401220
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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