Ghaly Galal, Rahouma Mohamed, Kamel Mohamed K, Nasar Abu, Harrison Sebron, Nguyen Andrew B, Port Jeffrey, Stiles Brendon M, Altorki Nasser K, Lee Paul C
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York.
Division of Thoracic Surgery, Department of Cardiovascular & Thoracic Surgery, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York.
Ann Thorac Surg. 2017 Oct;104(4):1153-1158. doi: 10.1016/j.athoracsur.2017.02.074. Epub 2017 May 24.
Despite the relatively high sensitivity of fluorodeoxyglucose-positron emission tomography (PET) and computed tomography (CT) scans used for staging of non-small cell lung cancer (NSCLC), a subset of patients with peripherally located clinical T1a N0 will be upstaged due to pathologic nodal disease. It is important to study this risk of upstaging, especially if local treatments, such as wedge resection or stereotactic body radiation therapy, are potential treatment modalities. Our aim was to determine the rate of pathologic N1/N2 disease in peripherally located clinical T1a N0 NSCLC and predictive factors for nodal metastasis.
A retrospective review of a prospective database (2000 to 2015) identified 1,342 patients with clinical T1a N0 NSCLC, and 914 (68%) underwent lobectomy. Among this group, 449 patients had peripherally located tumors and were deemed node negative by fluorodeoxyglucose-PET/CT scan. The relationship between clinicopathologic features and the PET maximal-standardized uptake value (SUVmax) of the primary tumor was investigated. Predictors for nodal metastasis were determined by multivariable logistic regression analysis. The receiver operating characteristic curve was used to assess the cutoff value of PET-SUVmax on the incidence of nodal metastasis.
Nodal metastasis was detected in 9.6% (43 of 449) of the patients: 4.5% (n = 20) had pN1 and 5.1% (n = 23) had pN2 metastasis. The relationship between SUVmax and development of pathologic nodal metastasis was calculated using the receiver operating characteristic curve with cutoff point at SUVmax of 3.3. In multivariable analysis, PET-SUVmax exceeding 3.3 was the only independent predictor for N1/N2 metastasis (p = 0.016). Disease-free survival showed a trend of poor survival for patients with nodal metastasis (p = 0.068).
High PET-SUVmax of the primary tumor is associated with elevated risk of nodal disease for peripheral T1a N0 NSCLC patients. Further diagnostic procedures, such as endobronchial ultrasound, may be required, especially if wedge resection or stereotactic body radiation therapy are being considered.
尽管用于非小细胞肺癌（NSCLC）分期的氟脱氧葡萄糖正电子发射断层扫描（PET）和计算机断层扫描（CT）具有相对较高的敏感性，但一部分临床分期为T1a N0的周围型患者会因病理淋巴结疾病而被上调分期。研究这种上调分期的风险很重要，特别是当局部治疗，如楔形切除术或立体定向体部放射治疗，是潜在的治疗方式时。我们的目的是确定周围型临床T1a N0 NSCLC患者的病理N1/N2疾病发生率以及淋巴结转移的预测因素。
对一个前瞻性数据库（2000年至2015年）进行回顾性分析，确定了1342例临床T1a N0 NSCLC患者，其中914例（68%）接受了肺叶切除术。在这组患者中，449例有周围型肿瘤，并且通过氟脱氧葡萄糖-PET/CT扫描被认为淋巴结阴性。研究了临床病理特征与原发肿瘤的PET最大标准化摄取值（SUVmax）之间的关系。通过多变量逻辑回归分析确定淋巴结转移的预测因素。使用受试者工作特征曲线评估PET-SUVmax对淋巴结转移发生率的临界值。
449例患者中有9.6%（43例）检测到淋巴结转移：4.5%（n = 20）为pN1转移，5.1%（n = 23）为pN2转移。使用受试者工作特征曲线计算SUVmax与病理淋巴结转移发生之间的关系，临界值为SUVmax 3.3。在多变量分析中，PET-SUVmax超过3.3是N1/N2转移的唯一独立预测因素（p = 0.016）。无病生存期显示淋巴结转移患者的生存趋势较差（p = 0.068）。
对于周围型T1a N0 NSCLC患者，原发肿瘤的高PET-SUVmax与淋巴结疾病风险升高相关。可能需要进一步的诊断程序，如支气管内超声检查，特别是在考虑楔形切除术或立体定向体部放射治疗时。
