Nakamura Haruhiko, Saji Hisashi, Marushima Hideki, Tagaya Rie, Kimura Hiroyuki, Takagi Masayuki
Department of Chest Surgery, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, Japan.
Department of Pathology, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, Japan.
Thorac Cardiovasc Surg. 2017 Mar;65(2):150-157. doi: 10.1055/s-0036-1572510. Epub 2016 Feb 24.
To assess the reliability of maximum standardized uptake values (SUVmax) at the primary lesion in 18-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) for identifying patients with lung cancer who were most likely to be cured by sublobar resection (SR). We retrospectively reviewed the medical records of 120 patients who underwent SR for clinical (c)-stage IA + IB lung cancer after FDG-PET/CT. Various factors, including tumor size, SUVmax at the primary site, and microscopic tumor invasion, were examined to identify their association with postsurgical survival. Prognoses of patients undergoing SR were compared with those of 272 patients undergoing lobectomy and lymphadenectomy during the same period. The 5-year recurrence-free survival (RFS) and overall survival (OS) rates in all patients undergoing SR for c-stage IA + IB disease were 79.5% and 82.2%, respectively. In multivariate analysis, a lack of microscopic pleural invasion and SUVmax ≤ 3.0 significantly correlated with better RFS and OS in patients undergoing SR. Though there were no significant differences in RFS and OS following SR and lobectomy for c-stage IA + IB or IA disease, RFS was significantly inferior in nonintentional SR (NISR) than in lobectomy in c-stage IA disease (< 0.01). However, in NISR identified based on SUVmax ≤ 2.0, RFS was comparable to those in lobectomy ( = 0.5371). When certain subgroups of patients are accurately identified based on preoperative SUVmax, SR can be a highly curative surgical method for lung cancer.
评估18-氟脱氧葡萄糖正电子发射断层扫描联合计算机断层扫描（FDG-PET/CT）中，原发灶最大标准化摄取值（SUVmax）用于识别最有可能通过亚肺叶切除术（SR）治愈的肺癌患者的可靠性。我们回顾性分析了120例接受FDG-PET/CT检查后因临床（c）-IA期+IB期肺癌接受SR的患者的病历。研究了包括肿瘤大小、原发部位SUVmax和微观肿瘤浸润等各种因素，以确定它们与术后生存的关联。将接受SR的患者的预后与同期接受肺叶切除术和淋巴结清扫术的272例患者的预后进行比较。所有接受SR治疗c-IA期+IB期疾病的患者的5年无复发生存率（RFS）和总生存率（OS）分别为79.5%和82.2%。多因素分析显示，微观胸膜无浸润和SUVmax≤3.0与接受SR的患者更好的RFS和OS显著相关。虽然c-IA期+IB期或IA期疾病接受SR和肺叶切除术后的RFS和OS没有显著差异，但c-IA期疾病中，非计划性SR（NISR）的RFS显著低于肺叶切除术（<0.01）。然而，在基于SUVmax≤2.0确定的NISR中，RFS与肺叶切除术相当（=0.5371）。当根据术前SUVmax准确识别特定亚组患者时，SR可以成为一种治疗肺癌的高效手术方法。
