Korean J Thorac Cardiovasc Surg.  2019 Aug;52(4):221-226. 10.5090/kjtcs.2019.52.4.221.

Preoperative Risk Factors for Pathologic N2 Metastasis in Positron Emission Tomography-Computed Tomography–Diagnosed N0–1 Non-Small Cell Lung Cancer

• Yoon TH
• Lee CH
• Park KS
• Bae CH
• Cho JW
• Jang JS

• KMID: 2455147
• DOI: http://doi.org/10.5090/kjtcs.2019.52.4.221

Abstract

BACKGROUND
Accurate mediastinal lymph node staging is vital for the optimal therapy and prognostication of patients with lung cancer. This study aimed to determine the preoperative risk factors for pN2 disease, as well as its incidence and long-term outcomes, in patients with clinical N0-1 non-small cell lung cancer.
METHODS
We retrospectively analyzed patients who were treated surgically for primary non-small cell lung cancer from November 2005 to December 2014. Patients staged as clinical N0-1 via chest computed tomography (CT) and positron emission tomography (PET)-CT were divided into two groups (pN0-1 and pN2) and compared.
RESULTS
In a univariate analysis, the significant preoperative risk factors for pN2 included a large tumor size (p=0.083), high maximum standard uptake value on PET (p<0.001), and central location of the tumor (p<0.001). In a multivariate analysis, central location of the tumor (p<0.001) remained a significant preoperative risk factor for pN2 status. The 5-year overall survival rates were 75% and 22.9% in the pN0-1 and pN2 groups, respectively, and 50% and 78.2% in the patients with centrally located and peripherally located tumors, respectively. In a Cox proportional hazard model, central location of the tumor increased the risk of death by 3.4-fold (p<0.001).
CONCLUSION
More invasive procedures should be considered when pre-operative risk factors are identified in order to improve the efficacy of diagnostic and therapeutic plans and, consequently, the patient's prognosis.

Keyword

Non-small-cell lung carcinoma; Lymph nodes; Neoplasm metastasis; Positron emission tomography; Computed tomography

MeSH Terms

Carcinoma, Non-Small-Cell Lung*
Electrons*
Humans
Incidence
Lung Neoplasms
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis*
Positron-Emission Tomography
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors*
Survival Rate
Thorax