Alberto Lopez-Pastorini, Zehra Tatli, Antonia von Bargen, Dennis Faltenberg, Hendrik Beling, Aris Koryllos, Thomas Galetin, Erich Stoelben
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Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, <i>p</i> = 0.009), a higher number of lymph node resection (17 ± 10 vs. 13 ± 8, <i>p</i> = 0.001), and a higher rate of L1 involvement (34 vs. 16%, <i>p</i> < 0.001) than nonupstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, <i>p</i> = 0.031) and higher rates of R1 (9 vs. 1%, <i>p</i> = 0.006) and L1 (39 vs. 20%, <i>p</i> < 0.026) than patients without nodal involvement. The 3- and 5-year overall survival rates for nonupstaged and upstaged patients were 85 and 67% and 67 and 54%, respectively (<i>p</i> = 0.040). In logistic regression, L1 involvement (odds ratio [OR]: 2.394, <i>p</i> = 0.005) and the number of dissected lymph nodes (OR: 1.037, <i>p</i> = 0.016) were independently associated with upstaging. Patients who received PET as part of clinical staging did not have a significantly lower nodal upstaging.</p><p><strong>Conclusion: </strong> Selective use of PET/CT based on the results of CT may be a viable option for patients with proven or suspected NSCLC up to 2 cm in size.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Staging of Early-Stage Lung Cancer without Routine PET in Candidates for Segmentectomy.\",\"authors\":\"Alberto Lopez-Pastorini, Zehra Tatli, Antonia von Bargen, Dennis Faltenberg, Hendrik Beling, Aris Koryllos, Thomas Galetin, Erich Stoelben\",\"doi\":\"10.1055/a-2405-2603\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong> We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC) scheduled for segmentectomy.</p><p><strong>Methods: </strong> A total of 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method. Logistic regression was performed to investigate factors independently associated with pathologic upstaging.</p><p><strong>Results: </strong> The Union for International Cancer Control (UICC) upstaging was found in 86 patients (28%). Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, <i>p</i> = 0.009), a higher number of lymph node resection (17 ± 10 vs. 13 ± 8, <i>p</i> = 0.001), and a higher rate of L1 involvement (34 vs. 16%, <i>p</i> < 0.001) than nonupstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, <i>p</i> = 0.031) and higher rates of R1 (9 vs. 1%, <i>p</i> = 0.006) and L1 (39 vs. 20%, <i>p</i> < 0.026) than patients without nodal involvement. The 3- and 5-year overall survival rates for nonupstaged and upstaged patients were 85 and 67% and 67 and 54%, respectively (<i>p</i> = 0.040). In logistic regression, L1 involvement (odds ratio [OR]: 2.394, <i>p</i> = 0.005) and the number of dissected lymph nodes (OR: 1.037, <i>p</i> = 0.016) were independently associated with upstaging. 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引用次数: 0
摘要
简介方法:对305例连续分段切除术进行了回顾性分析。采用 Kaplan-Meier 法计算总生存率。采用逻辑回归法研究与病理分期相关的独立因素:结果:86例患者(28%)发现了UICC上分期。与未分期患者相比,上分期患者的手术时间更长(146±46分钟 vs. 131±44分钟,p= 0.009),切除的淋巴结数量更多(17±10 vs. 13±8,p= 0.001),L1受累率更高(34% vs. 16%,p< 0.001)。10名患者(3%)发现N1,13名患者(4%)发现N2。与无结节受累的患者相比,结节阳性患者的手术时间更长(154 ± 50 分钟对 133 ± 44 分钟,p= 0.031),R1(9% 对 1%,p= 0.006)和 L1(39% 对 20%,p< 0.026)率更高。分期和未分期患者的3年和5年总生存率分别为67%和54%,以及85%和67%(P=0.040)。在逻辑回归中,L1受累(OR 2.394,p= 0.005)和切除淋巴结的数量(OR 1.037,p= 0.016)与上分期独立相关。接受 PET 作为临床分期一部分的患者的结节向上分期并没有明显降低:结论:根据计算机断层扫描结果有选择性地使用 PET/CT 可能是 2 厘米以下已证实或疑似 NSCLC 患者的可行选择。
Staging of Early-Stage Lung Cancer without Routine PET in Candidates for Segmentectomy.
Introduction: We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC) scheduled for segmentectomy.
Methods: A total of 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method. Logistic regression was performed to investigate factors independently associated with pathologic upstaging.
Results: The Union for International Cancer Control (UICC) upstaging was found in 86 patients (28%). Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, p = 0.009), a higher number of lymph node resection (17 ± 10 vs. 13 ± 8, p = 0.001), and a higher rate of L1 involvement (34 vs. 16%, p < 0.001) than nonupstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, p = 0.031) and higher rates of R1 (9 vs. 1%, p = 0.006) and L1 (39 vs. 20%, p < 0.026) than patients without nodal involvement. The 3- and 5-year overall survival rates for nonupstaged and upstaged patients were 85 and 67% and 67 and 54%, respectively (p = 0.040). In logistic regression, L1 involvement (odds ratio [OR]: 2.394, p = 0.005) and the number of dissected lymph nodes (OR: 1.037, p = 0.016) were independently associated with upstaging. Patients who received PET as part of clinical staging did not have a significantly lower nodal upstaging.
Conclusion: Selective use of PET/CT based on the results of CT may be a viable option for patients with proven or suspected NSCLC up to 2 cm in size.
期刊介绍:
The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field.
Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.