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M. Endo
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-014 - Surgical Outcome and Diagnosis of cN1 Lung Cancers after Introducing PET/CT (ID 4692)
14:30 - 14:30 | Author(s): M. Endo
- Abstract
Background:
The mainstay of therapy for cN1 lung cancer is surgery; however, the pre-operative radiologic assessment of cN1 lung cancer remains challenging and it has been reported that approximately 30% of cN1 cases are pathologically pN2. The aim of this study was to determine the pre-operative evaluation and outcomes of patients with cN1 lung cancer.
Methods:
A prospectively-collected institutional database was used. In the current study, cN1 was defined as hilar lymph nodes 1 cm in the short axis on CT and standardized uptake values > 2.5 on PET/CT. Between January 2004 and March 2016, a total of 1082 lung cancer patients underwent surgery. After excluding patients who received pre-operative treatment or had an incomplete resection, 86 (7.9%) cN1 patients were retrospectively studied. We compared the characteristics and prognosis of cN1 patients with 783 (72.4%) cN0 patients. Because the patients with cN1pN2 were underestimated, we investigated the frequency and predictive factors for cN1pN2.
Results:
The median follow-up time was 48 months. Compared with cN0 patients, the proportion of males, smokers, and squamous cell carcinomas was higher in cN1 patients (p < 0.01). In addition, cN1 patients had elevated CEA levels and increased SUV on PET/CT. Lymph node metastases were noted as follows: cN1pN0, 32 (37.2%); cN1pN1, 37 (43.0%); cN1pN2, 17 (19.8%); cN0pN0, 701 (89.5%); cN0pN1, 50 (6.4%); and cN0pN2, 32 (4.1%). Lymph node metastases were underestimated in 99 cN0 and cN1 patients (11.4%). The incidence of pN2 was higher in cN1 cases (p < 0.01). The 5-year survival for cN1 cases was 51.9%. The 5-year overall survival of the underestimated cases was as follows: cN1pN2, 18.0%; cN0pN1, 63.7%; and cN0pN2, 39.5%. Among the underestimated cases, survival of cN1pN2 patients was significantly reduced (p < 0.01). In addition, univariate analysis showed that smoking (p = 0.04) and peripheral tumors (p < 0.01) were predictive factors for cN1pN2. Multivariate analysis confirmed that cN1 peripheral tumors tended to be pN2. In 44 cases with peripheral tumors and cN1, 14 (31.8%) were pN2.
Conclusion:
PET/CT can decrease the number of underestimated patients with cN1 lung cancer. Amongst cN1 lung cancer patients, pN2 existed in approximately 20% of cases. Especially, since around 30% of peripheral tumors with cN1 were pN2, invasive staging would be warranted before the treatment.
