Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
J Thorac Cardiovasc Surg. 2012 Dec;144(6):1365-71. doi: 10.1016/j.jtcvs.2012.07.012. Epub 2012 Aug 9.
Patients with pathologic node-negative early lung cancer may be optimal candidates for sublobar resection. We aimed to identify predictors of pathologic lymph node involvement in clinical stage IA lung adenocarcinoma.
The data from a multicenter database of 502 patients with completely resected clinical stage IA lung adenocarcinoma were retrospectively analyzed to determine the relationship between the lymph node metastasis status and tumor size on high-resolution computed tomography (HRCT) or maximum standardized uptake value (SUVmax) on [18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT). Revised SUVmax was used to correct interinstitutional discrepancies.
In multivariate analyses, either a solid tumor size on HRCT (P = .001) or an SUVmax on FDG-PET/CT (P = .049) was an independent predictor of lymph node metastasis. The predictive criteria of pathologic node-negative early lung cancer were a solid tumor size of less than 0.8 cm or an SUVmax of less than 1.5. Patients who met the predictive criteria of pathologic node-negative disease had less pathologic invasiveness, such as lymphatic, vascular, or pleural invasion (P < .001), and better disease-free survival (P < .0001) than those who did not, and 86 (40.4%) of the 213 patients with T1b (2-3 cm) tumors met the predictive criteria.
Either a solid tumor size or an SUVmax was a significant independent predictor of nodal involvement in clinical stage IA lung adenocarcinoma. The pathologic node-negative status criteria of a solid tumor size of less than 0.8 cm on HRCT or an SUVmax of less than 1.5 on FDG-PET/CT may be helpful for avoiding systematic lymphadenectomy for clinical stage IA lung adenocarcinoma, even in cases of T1b (2-3 cm) tumor.
病理淋巴结阴性的早期肺癌患者可能是亚肺叶切除术的最佳选择。本研究旨在确定临床 I 期肺腺癌中预测病理淋巴结受累的因素。
回顾性分析了 502 例完全切除的临床 I 期肺腺癌多中心数据库中的数据，以确定淋巴结转移状态与高分辨率计算机断层扫描（HRCT）上肿瘤大小或 [18F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）上最大标准化摄取值（SUVmax）之间的关系。使用修订后的 SUVmax 来校正机构间差异。
在多变量分析中，HRCT 上的实性肿瘤大小（P =.001）或 FDG-PET/CT 上的 SUVmax（P =.049）是淋巴结转移的独立预测因素。病理淋巴结阴性早期肺癌的预测标准为实性肿瘤直径小于 0.8cm 或 SUVmax 小于 1.5。符合病理淋巴结阴性疾病预测标准的患者，其病理侵袭性较小，如淋巴管、血管或胸膜侵犯（P <.001），且无病生存（P <.0001）更好，213 例 T1b（2-3cm）肿瘤患者中有 86 例（40.4%）符合预测标准。
HRCT 上的实性肿瘤大小或 FDG-PET/CT 上的 SUVmax 是临床 I 期肺腺癌淋巴结受累的显著独立预测因素。HRCT 上实性肿瘤直径小于 0.8cm 或 FDG-PET/CT 上 SUVmax 小于 1.5 的病理淋巴结阴性状态标准可能有助于避免对临床 I 期肺腺癌进行系统性淋巴结清扫，即使是 T1b（2-3cm）肿瘤也是如此。
