Author of

• 12701

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  P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12718

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    P3.12-017 - The lack of impact of pre-operative PET on the risk, and pace, of subsequent failure following surgery for early stage non-small cell lung cancer? (ID 2901)

    09:30 - 09:30  |  Author(s): T. Zagar
    • Abstract

    Background
    PET scans are generally believed to be more sensitive than are CT in detecting metastatic disease and thus are widely used in the pre-operative assessment of patients with early-stage lung cancer. Given the increased sensitivity afforded with PET, one would expect the PET-staged patients to be “more favorable” than their “CT-staged only” patients (i.e. “stage migration”). The PET-staged patients should theoretically have a lower rate of subsequent distant failure. Further, among those who fail, the PET-staged patients should theoretically fail at a later time post-operatively (compared to their CT-only-staged patients). We herein compare the clinical outcomes in a group of patients with early stage lung cancer staged pre-operatively with CT with or without PET scan.

    Methods
    The records of 335 patients undergoing curative surgery at UNC hospital between January 1996 through December 2006 were retrospectively reviewed, with extensive data extraction including staging, treatment, and outcome data. Univariate and multivariate analysis were performed to identify predictors for clinical outcome. Failure times in sub-groups were calculated with the Kaplan–Meier method and compared via log-rank test. The rate and pace of recurrence were considered. Independent factors adversely affecting failure were determined with Cox regression.

    Results
    Figure 1112/335 patients (33%) had pre-operative staging PET scans. For the overall group (n= 335), and for the N0 (n=256) and N1 (n=79) subgroups, there was no evidence that the use of a pre-operative PET scan was associated with a lesser rate of subsequent distant failure, or a slower rate of distant failure (p>0.05 on uni- and multi-variate analyses) (Figure-1). On multivariate analysis, the predictors of distant failure included lympho-vascular invasion (p=0.02, HR=1.3), T stage (T1-2 vs T3) (p=0.009, HR=1.4) and N stage (N0 vs N1) (p=0.007, HR=1.5). The predictors for recurrent disease included lympho-vascular invasion (p=0.004, HR=1.8), T stage (p=0.001, HR=1.3) and N stage (p=0.004, HR=1.7).

    Conclusion
    The use of a pre-operative PET scan did not significantly alter the rate, or the pace, of distant recurrence or relapse of any kind, in patients undergoing surgery for non-small cell lung cancer (compared to CT-only staged patients). The retrospective nature of this study limits its validity. However, the PET-scanned patients were treated more recently, and were therefore perhaps more favorable (with both shorter follow up and with access to more modern interventions).