Department of Thoracic Surgery, Austin Health, Heidelberg, Victoria, Australia.
Eur J Cardiothorac Surg. 2011 Jan;39(1):96-101. doi: 10.1016/j.ejcts.2010.04.040. Epub 2010 Jul 1.
Prognostic information known preoperatively allows stratification of patients to surgery; induction therapy and surgery; or definitive chemoradiotherapy and may prevent a futile thoracotomy. Attention has focussed on the standard uptake value (SUV) of the primary tumour but less has been described regarding the 18F-fluoro-2-deoxy-D-glucose (18F-FDG) avidity of mediastinal nodes. We aimed, in a group of surgically resected cN0-1 but pN2 tumours, to compare the survival of patients with and without 18F-FDG avid mediastinal nodes.
Retrospective review of a surgical database identified cN0-1 non-small-cell lung cancer (NSCLC) patients with pN2 disease after resection. Survival of non-FDG avid N2 versus FDG avid N2 groups was compared after stratification according to variables found on univariate analysis to affect survival.
From January 1993 to December 2006, 42 patients were identified; 27 (64%) had non-FDG avid N2 disease. Five-year and median survival were better in the non-FDG avid N2 disease group, 25% versus 0% and 30 (16-44) versus 13 (10-16) months, respectively (p=0.02). After 1998, the difference in survival was 41% versus 0% and 35 (14-56) versus 12 (16-18) months, respectively (p=0.02).
After resection, patients with non-FDG avid N2 disease have better survival than patients with FDG avid N2 disease. Exploratory thoracotomy alone (after frozen section analysis) cannot be advocated in patients with non-FDG avid N2 disease as survival after resection appears at least equivalent to alternate therapeutic approaches in this group. This assertion may be tempered if right pneumonectomy is required or R0 resection is unachievable. Mediastinal nodal avidity may improve stratification in future studies of long-term survival in NSCLC.
术前获得的预后信息可用于对患者进行手术分层；诱导治疗和手术；或明确的放化疗，并且可以避免进行无效的开胸手术。人们关注的焦点是原发肿瘤的标准摄取值（SUV），但对于纵隔淋巴结的 18F-氟代-2-脱氧-D-葡萄糖（18F-FDG）摄取描述较少。我们旨在一组接受手术切除的 cN0-1 但 pN2 肿瘤患者中，比较 18F-FDG 摄取的纵隔淋巴结阳性和阴性患者的生存情况。
回顾性分析手术数据库，确定接受切除术后 pN2 疾病的 cN0-1 非小细胞肺癌（NSCLC）患者。根据单变量分析中发现的影响生存的变量进行分层后，比较非 FDG 摄取的 N2 与 FDG 摄取的 N2 组的生存情况。
从 1993 年 1 月至 2006 年 12 月，共确定了 42 名患者；其中 27 名（64%）患有非 FDG 摄取的 N2 疾病。非 FDG 摄取的 N2 疾病组的 5 年和中位生存率更好，分别为 25%和 0%，30（16-44）和 13（10-16）个月（p=0.02）。1998 年后，生存率的差异分别为 41%和 0%，35（14-56）和 12（16-18）个月（p=0.02）。
切除后，非 FDG 摄取的 N2 疾病患者的生存率优于 FDG 摄取的 N2 疾病患者。在非 FDG 摄取的 N2 疾病患者中，单纯的探索性开胸术（在冷冻切片分析后）不能被提倡，因为在该组中，切除后的生存率至少与其他治疗方法相当。如果需要右全肺切除术或无法实现 R0 切除术，则这一说法可能需要调整。纵隔淋巴结摄取可能会改善 NSCLC 患者长期生存的未来研究中的分层。
