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K. Asakura
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-001 - Predictors of Occult Nodal Metastasis in Clinical Stage I NSCLC Staged by FDG-PET/CT (ID 273)
09:30 - 09:30 | Author(s): K. Asakura
- Abstract
Background:
Integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is widely used for lymph node staging in patients with non-small cell lung cancer (NSCLC). However, FDG-PET/CT has certain limitations. If N0 cases staged by FDG-PET/CT were reliable, anatomy resection and systematic lymph node dissection might be avoided. And prediction of occult nodal metastasis could allow selection of candidates for preoperative cervical mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration. This study defined risk factors for occult nodal metastasis in patients with NSCLC patients who were diagnosed as clinical stage I by preoperative integrated FDG-PET/CT.
Methods:
We retrospectively reviewed the records of 423 NSCLC patients who underwent surgical resection from April 2007 to March 2015 at the department of Thoracic Surgery, Sagamihara Kyodo Hospital. No preoperative mediastinoscopy was carried out in this group and all underwent curative intent surgical resection. The following patients were excluded from the present study: those who were diagnosed as clinical stage IIA/IIB/IIIA by preoperative integrated FDG-PET/CT (n = 101), patients who underwent limited resection (wide-wedge resection or segmentectomy; n = 62), patients who received neo-adjuvant chemotherapy or radiotherapy (n = 1), and patients with preoperative integrated FDG-PET/CT was not performed (n = 20). The remaining 239 patients who were diagnosed as clinical stage I NSCLC were identified. They underwent surgical resection with systematic lymph node dissection. The prevalence of occult nodal metastasis in patients as clinical stage I was analyzed according to clinicopathological factors such as gender, age, smoking status, history of lung disease, serum carcinoembryonic antigen (CEA) level, concurrent diabetes, histopathological type, grade, tumor side, tumor localization, primary tumor location (central, non-central), tumor size (cm), pleural invasion, standardized uptake value (SUV) max of primary tumor. Risk factors for occult nodal metastasis were defined by univariate and multivariate analysis.
Results:
Occult nodal metastasis was detected in 12.5% (30/239) of the patients. N1 involvement was identified in 5.0% (12/239) of the patients and N2 disease was identified in 7.5% (18/239). An optimal cut-off value of primary tumor SUVmax for occult nodal metastasis was identified as 3.0 by the receiver operator characteristic (ROC) curve, the sensitivity and specificity were 90.0% and 42.1% respectively. In univariate analysis, the following were significant predictors of occult nodal metastasis: adenocarcinoma (P = 0.023), tumor size >3cm (P = 0.002), pleural invasion (P = 0.034) and SUVmax of primary tumor >3.0 (P = 0.018). In multivariate analysis, the following were independent predictors of occult nodal metastasis: adenocarcinoma (P = 0.006), tumor size >3cm (P = 0.013), and SUVmax of primary tumor >3.0 (P = 0.033).
Conclusion:
The present study demonstrated that adenocarcinoma, tumor size >3 cm, and SUVmax of primary tumor > 3.0 are risk factors for occult nodal metastasis in patients with NSCLC who were diagnosed as clinical stage I by preoperative integrated FDG-PET/CT.This study may provide some aids to pre-therapy evaluation and decision-making.
