Comparison of prognostic values of primary tumor and nodal 18F-fluorodeoxyglucose uptake in non-small cell lung cancer with N1 disease

  • Chae Hong Lim
  • Seung Hyup Hyun
  • Seung Hwan Moon
  • Young Seok Cho
  • Joon Young Choi
  • Kyung-Han LeeEmail author
Nuclear Medicine



We hypothesized that, in non-small cell lung cancer (NSCLC) with N1 metastasis, N1 nodal 18F-fluorodeoxyglucose (FDG) status offers independent and incremental prognostic value.


We enrolled 106 NSCLC patients with pathology-confirmed N1 metastasis. N1 node FDG positivity, primary tumor maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Kaplan-Meier method and Cox regression analyses were performed for cancer-specific survival (CSS) and disease-free survival (DFS).


Subjects were 67 males and 39 females (61.9 ± 9.4 years). Eighty-one (76.4%) and 25 (23.6%) had pathologic stage IIB and IIIA NSCLC, respectively. All underwent complete tumor resection. FDG-positive N1 nodes were larger and had higher primary tumor SUVmax. During a follow-up of 42 months, there were 56 recurrences and 31 cancer deaths. Significant univariate predictors were stage, no adjuvant therapy, and FDG-positive nodes for DFS, and stage, no adjuvant therapy, node size, tumor MTV, TLG, and SUVmax, and FDG-positive nodes for CSS. Independent predictors on multivariate analyses were FDG-positive nodes (HR = 3.071, p = 0.003), greater tumor TLG (HR = 3.224, p = 0.002), and no adjuvant therapy (HR = 3.631, p < 0.001) for poor CSS, and FDG-positive nodes (HR = 1.771, p = 0.040) and no adjuvant therapy (HR = 2.666, p = 0.002) for poor DFS. Harrell’s concordance and net reclassification improvement tests showed that CSS prediction was significantly improved by the addition of N1 FDG status to a model containing tumor TLG.


N1 node FDG status can be useful for predicting the outcome of NSCLC patients with N1 metastasis beyond that provided by other prognostic variables.

Key Points

• In NSCLC with N1 disease, N1 node FDG status is useful as a prognostic predictor.

• FDG-positive N1 nodes provide additional prognostic value beyond TLG of primary tumor.

• Combining TLG of primary tumor and N1 node uptake can stratify the survival of patients.


Lung cancer Positron emission tomography Fluorodeoxyglucose F18 Lymph nodes 



Concordance index


Cancer-specific survival


Disease-free survival


Eastern Cooperative Group




Lymph nodes


Metabolic tumor volume


Net reclassification improvement


Non-small cell lung cancer


Positron emission tomography/computed tomography


Receiver operating characteristics


Maximum standard uptake value


Total lesion glycolysis



This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (# 2016R1C1B2013411).

Compliance with ethical standards


The scientific guarantor of this publication is Kyung-Han Lee.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

This work was supported by Kyunga Kim, Biostatics, Samsung Medical Center.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Chae Hong Lim
    • 1
  • Seung Hyup Hyun
    • 1
  • Seung Hwan Moon
    • 1
  • Young Seok Cho
    • 1
  • Joon Young Choi
    • 1
  • Kyung-Han Lee
    • 1
    Email author
  1. 1.Department of Nuclear Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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