Maximum standardized uptake (SUVmax) is associated with pathologically upstaged and recurrence-free survival in non-small cell lung cancer after curative surgery

Q: What was the study’s primary aim?

To evaluate the association between PET SUVmax and pathological upstaging and survival in patients with clinical stage IA (T1N0M0) NSCLC after curative surgery.

Q: How were patients selected and what time period was studied?

Patients with clinical stage IA NSCLC who underwent preoperative PET scans and curative surgery at Kaohsiung Veterans General Hospital were retrospectively reviewed from January 2015 to December 2021.

Q: What did the study find about SUVmax and pathological upstaging?

Pathologically upstaged patients had significantly higher SUVmax than those without upstaging.

Q: What SUVmax threshold predicted recurrence-free survival?

SUVmax ≥5 was an independent prognostic factor for recurrence-free survival, associated with a significantly lower median RFS compared with SUVmax <5.

Sep 23, 2026

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Elevated preoperative PET maximum standardized uptake (SUVmax) may reflect hidden tumor aggressiveness despite screening-driven early-stage detection. This study retrospectively analyzed clinical stage IA (T1N0M0) non-small cell lung cancer patients receiving preoperative PET and curative surgery, with pathological upstaging and recurrence-free survival as key endpoints. Pathologically upstaged cases showed higher SUVmax, and SUVmax ≥5 independently predicted poorer recurrence-free survival and shorter median RFS.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Patient Flow

Table 1: Clinical Characteristics

Li etal. World Journal of Surgical Oncology (2026) 24:279 [https://doi.org/10.1186/s12957-026-04397-1](https://doi.org/10.1186/s12957-026-04397-1) World Journal of Surgical Oncology RESEARCH Open Access Maximum standardized uptake (SUVmax) is associated with pathologically upstaged and recurrence-free survival in non-small cell lung cancer after curative surgery Chi-Yung Li1†, Ping-Chung Tsai1,2†, Chin Hu3, Kai-Yun Hsueh 1, Yen-Chiang Tseng1,2, Fu-Zong Wu4 and En-Kuei Tang1* Abstract Background Timely detection of early-stage lung cancer via screening programs has improved, but unexpected advanced disease might exist and influence the prognosis. This study aimed to investigate the association between positron emission tomography (PET) maximum standardized uptake (SUVmax) and pathological upstaging and survival in patients with clinical stage IA (T1N0M0) non-small cell lung cancer (NSCLC) . Methods We retrospectively reviewed patients with clinical stage IA NSCLC who underwent preoperative PET scansand curative surgery at Kaohsiung Veterans General Hospital from January 2015 to December 2021. The primary outcome was the rate of pathological upstaging, and a Cox regression model was used to identify prognostic factors for recurrence-free survival (RFS) . Results In total, 112 cases were included in this analysis, with a median observation time of 71.7 months. Forty-three patients (38 .4%) were pathologically upstaged, and the pathologically upstaged group had a significantly higher SUVmax than the non-upstaged group (p = 0 . 024) . Cox regression demonstrated that a SUVmax ≥5 was a significant independent prognostic factor for RFS (hazard ratio 6 . 698, 95% CI: 2 .031–22. 084, p < 0. 001) . In addition, there was a significant difference in the median RFS between the SUVmax ≥5 and SUVmax < 5 groups (48 .1 versus 77.4 months, p < 0. 001) . Conclusion Elevated preoperative PET SUVmax is associated with increased pathological upstaging, as well as a poorer RFS in clinical stage IA NSCLC. Although a PET SUVmax ≥5 was identified as a strong independent prognostic indicator of RFS in our cohort, this threshold should be interpreted cautiously. †Chi-Yung Li and Ping-Chung Tsai have contributed equally to this study. *Correspondence: En-Kuei Tang [ektang@vghks.gov.tw](ektang@vghks.gov.tw) 1Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 3Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 4Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Li et al. World Journal of Surgical Oncology (2026) 24:279 Introduction Lung cancer remains the most common cause of cancerrelated mort

FAQs

What was the study’s primary aim?

To evaluate the association between PET SUVmax and pathological upstaging and survival in patients with clinical stage IA (T1N0M0) NSCLC after curative surgery.

How were patients selected and what time period was studied?

Patients with clinical stage IA NSCLC who underwent preoperative PET scans and curative surgery at Kaohsiung Veterans General Hospital were retrospectively reviewed from January 2015 to December 2021.

What did the study find about SUVmax and pathological upstaging?

Pathologically upstaged patients had significantly higher SUVmax than those without upstaging.

What SUVmax threshold predicted recurrence-free survival?

SUVmax ≥5 was an independent prognostic factor for recurrence-free survival, associated with a significantly lower median RFS compared with SUVmax <5.

Sep 23, 2026

Uploaded by Guten tag