Department of Radiation Oncology, Duke University School of Medicine, Durham, NC.
J Thorac Cardiovasc Surg. 2013 Oct;146(4):796-801. doi: 10.1016/j.jtcvs.2013.05.027. Epub 2013 Jul 16.
Many patients with non-small cell lung cancer have positive mediastinal lymph nodes on preoperative positron emission tomography (PET) but do not have mediastinal involvement after surgery. The prognostic significance of this discordance was assessed.
This Institutional Review Board-approved study evaluated patients treated with upfront surgery at Duke Cancer Institute (Durham, NC) for non-small cell lung cancer from 1995 to 2008. Those staged with PET with pN0-1 disease after negative invasive mediastinal assessment were included. Mediastinal lymph nodes were scored as positive or negative based on visual analysis of the preoperative PET. Clinical outcomes of the PET-positive and PET-negative cohorts were estimated using the Kaplan-Meier method and compared using a log-rank test. Prognostic factors were assessed using a multivariate analysis.
A total of 547 patients were assessed, of whom 105 (19%) were PET positive in the mediastinum. The median number of mediastinal lymph node stations sampled was 4 (range, 1-9). The 5-year risk of local recurrence was 26% in PET-positive versus 21% in PET-negative patients (P = .50). Patterns of local failure were similar between the 2 groups. Distant recurrence (35% vs 29%; P = .63) and overall survival (44% vs 54%; P = .52) were comparable for PET-positive and PET-negative patients. On multivariate analysis, a positive PET was not significant for local recurrence (hazard ratio [HR], 1; P = 1), distant recurrence (HR, 0.82; P = .42), or overall survival (HR, 1.08; P = .62).
Patients with positive mediastinal lymph nodes on preoperative PET, but negative on histologic analysis, are not at increased risk of disease recurrence. Pathologic staging remains the standard.
许多非小细胞肺癌患者术前正电子发射断层扫描（PET）显示纵隔淋巴结阳性，但术后无纵隔侵犯。评估这种不相符的预后意义。
这项经机构审查委员会批准的研究评估了 1995 年至 2008 年在杜克癌症研究所（北卡罗来纳州达勒姆）接受手术治疗的非小细胞肺癌患者。那些经阴性侵袭性纵隔评估后 PET 分期为 pN0-1 疾病的患者被纳入研究。根据术前 PET 的视觉分析，将纵隔淋巴结评分分为阳性或阴性。使用 Kaplan-Meier 方法估计 PET 阳性和 PET 阴性队列的临床结局，并使用对数秩检验进行比较。使用多变量分析评估预后因素。
共评估了 547 例患者，其中 105 例（19%）纵隔 PET 阳性。纵隔淋巴结取样的中位淋巴结站数为 4（范围 1-9）。PET 阳性患者的 5 年局部复发风险为 26%，PET 阴性患者为 21%（P=0.50）。两组局部复发模式相似。两组远处复发（35%比 29%；P=0.63）和总生存率（44%比 54%；P=0.52）相当。多变量分析显示，PET 阳性与局部复发（风险比[HR]，1；P=1）、远处复发（HR，0.82；P=0.42）或总生存率（HR，1.08；P=0.62）无关。
术前 PET 显示纵隔淋巴结阳性但组织学分析为阴性的患者疾病复发风险并未增加。病理分期仍是标准。
