Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China.
Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Eur Radiol. 2023 Dec;33(12):8564-8572. doi: 10.1007/s00330-023-09910-8. Epub 2023 Jul 18.
The performance of positron emission tomography/computed tomography (PET/CT) for the prediction of ypN2 disease in non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy has not been reported. This multicenter study investigated the utility of PET/CT to assess ypN2 disease in these patients.
A total of 181 consecutive patients (chemoimmunotherapy = 86, chemotherapy = 95) at four institutions were enrolled in this study. Every patient received a PET/CT scan prior to surgery and complete resection with systematic nodal dissection. The diagnostic performance was evaluated through area under the curve (AUC). Kaplan-Meier method and Cox analysis were performed to identify the risk factors affecting recurrences.
The sensitivity, specificity, and accuracy of PET/CT for ypN2 diseases were 0.667, 0.835, and 0.779, respectively. Therefore, the AUC was 0.751. Compared with the false positive cases, the mean value of max standardized uptake value (SUV) (6.024 vs. 2.672, p < 0.001) of N2 nodes was significantly higher in true positive patients. Moreover, the SUV of true positive (7.671 vs. 5.976, p = 0.365) and false (2.433 vs. 2.339, p = 0.990) positive cases were similar between chemoimmunotherapy and chemotherapy, respectively. Survival analysis proved that pathologic N (ypN) 2 patients could be stratified by PET/CT-N2(+ vs. -) for both chemoimmunotherapy (p = 0.023) and chemotherapy (p = 0.010).
PET/CT is an accurate and non-invasive test for mediastinal restaging of NSCLC patients who receive neoadjuvant chemoimmunotherapy. The ypN2 patients with PET/CT-N2( +) are identified as an independent prognostic factor compared with PET/CT-N2(-).
Imaging with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) plays an integral role during disease diagnosis, staging, and therapeutic response assessments in patients with NSCLC. PET/CT could be an effective non-invasive tool for predicting ypN2 diseases after neoadjuvant chemoimmunotherapy.
• PET/CT could serve as an effective non-invasive tool for predicting ypN2 diseases. • The ypN2 patients with PET/CT-N2( +) were a strong and independent prognostic factor. • The application of PET/CT for restaging should be encouraged in clinical practice.
新辅助化疗免疫治疗后非小细胞肺癌（NSCLC）患者预测ypN2 疾病的正电子发射断层扫描/计算机断层扫描（PET/CT）性能尚未见报道。本多中心研究旨在探讨 PET/CT 评估此类患者 ypN2 疾病的效用。
本研究纳入了 4 个机构的 181 例连续患者（化疗免疫治疗组=86 例，化疗组=95 例）。每位患者均在手术前接受 PET/CT 扫描，并进行系统淋巴结清扫术的完全切除。通过曲线下面积（AUC）评估诊断性能。使用 Kaplan-Meier 方法和 Cox 分析确定影响复发的危险因素。
PET/CT 对 ypN2 疾病的敏感性、特异性和准确性分别为 0.667、0.835 和 0.779，因此 AUC 为 0.751。与假阳性病例相比，真阳性患者 N2 节点的最大标准化摄取值（SUV）的平均值（6.024 比 2.672，p<0.001）明显更高。此外，真阳性（7.671 比 5.976，p=0.365）和假阳性（2.433 比 2.339，p=0.990）病例的 SUV 值在化疗免疫治疗和化疗之间相似。生存分析证明，对于接受新辅助化疗免疫治疗的 NSCLC 患者，可根据 PET/CT-N2（+ 与 -）对病理 N（ypN）2 患者进行分层，化疗免疫治疗（p=0.023）和化疗（p=0.010）。
PET/CT 是一种准确且非侵入性的检查方法，可用于评估接受新辅助化疗免疫治疗的 NSCLC 患者的纵隔再分期。与 PET/CT-N2（-）相比，PET/CT-N2（+）的 ypN2 患者是一个独立的预后因素。
在 NSCLC 患者的疾病诊断、分期和治疗反应评估中，18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）成像起着重要作用。PET/CT 可能是新辅助化疗免疫治疗后预测 ypN2 疾病的有效非侵入性工具。
• PET/CT 可作为预测 ypN2 疾病的有效非侵入性工具。• PET/CT-N2（+）的 ypN2 患者是一个强大且独立的预后因素。• 应鼓励在临床实践中使用 PET/CT 进行再分期。
