Guinde Julien, Bourdages-Pageau Etienne, Ugalde Paula Antonia, Fortin Marc
Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.
J Thorac Dis. 2020 Dec;12(12):7156-7163. doi: 10.21037/jtd-20-1565.
Appropriate pre-operative staging is a cornerstone in the treatment of non-small cell lung cancer (NSCLC). Central location and size greater than 3 cm are amongst indications for pre-operative invasive mediastinal staging but the quality of the evidence behind this recommendation is low.
We retrospectively reviewed all cases of cT2-4N0M0 NSCLCL after CT and TEP-CT which underwent surgical resection with lymph node dissection or had a positive invasive pre-operative mediastinal staging in our institution from 2014 to 2018.
Three hundred and ten patients met inclusion criteria, 79 (25.5%) central and 231 (74.5%) peripheral tumors. Central tumor location was associated with a higher prevalence of pN2-3 disease (17.7% 6.1%, P<0.001). In a multivariate analysis, central tumor location remained the only factor statistically associated with imaging occult mediastinal disease (OR 3.23, 95% CI: 1.45-7.18). NPV of PET-CT for occult mediastinal disease was 0.83 (95% CI: 0.72-0.90) in central and 0.94 (95% CI: 0.90-0.97) in peripheral tumor. Central location was also associated with a higher prevalence of occult N1 to N3 disease (43.0% 15.2%, P<0.001).
This study suggests that invasive mediastinal staging is required in central cT2-4N0 NSCLC but can be questioned in peripheral one, especially in cT2N2 subgroup if the patient is a candidate for lobar resection.
合适的术前分期是治疗非小细胞肺癌（NSCLC）的基石。肿瘤位于中央且直径大于3 cm是术前进行有创纵隔分期的指征，但该推荐背后的证据质量较低。
我们回顾性分析了2014年至2018年在我院接受手术切除并进行淋巴结清扫或术前有创纵隔分期为阳性的cT2-4N0M0 NSCLC患者的所有病例，这些患者均接受了CT和TEP-CT检查。
310例患者符合纳入标准，其中79例（25.5%）为中央型肿瘤，231例（74.5%）为周围型肿瘤。中央型肿瘤与pN2-3疾病的较高患病率相关（17.7%对6.1%，P<0.001）。在多因素分析中，中央型肿瘤位置仍然是与影像学隐匿性纵隔疾病唯一有统计学关联的因素（OR 3.23，95%CI：1.45-7.18）。PET-CT对隐匿性纵隔疾病的阴性预测值在中央型肿瘤中为0.83（95%CI：0.72-0.90），在周围型肿瘤中为0.94（95%CI：0.90-0.97）。中央型肿瘤位置也与隐匿性N1至N3疾病的较高患病率相关（43.0%对15.2%，P<0.001）。
本研究表明，中央型cT2-4N0 NSCLC需要进行有创纵隔分期，但周围型则可质疑，特别是对于cT2N2亚组患者，如果其适合进行肺叶切除。
