Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review

Current Oncology

T. Shaipanich³  J. Yee¹  D. Wilson³  Y. Zhai²  C. Ho³  S. Lam³  K. Ramsden³  J. Laskin³  M. Smoragiewicz³ 

[1] Vancouver General Hospital;University of British Columbia;British Columbia Cancer Agency

关键词: non-small-cell lung cancer;    positron-emission tomography–computed tomography;    thoracotomy;    lymphatic metastasis or pathology;    mediastinal staging;    endobronchial ultrasonography;    mediastinoscopy;    endoscopic ultrasonography;   

DOI  :  

学科分类：肿瘤学

来源: Multimed, Inc.

【 摘 要 】

Background Combined positron-emission tomography and computed tomography (pet-ct) reduces futile thoracotomy (ft) rates in patients with non-small-cell lung cancer (nsclc). We sought to identify preoperative risk factors for ft in patients staged with pet-ct. Methods We retrospectively reviewed all patients referred to the BC Cancer Agency during 2009–2010 who underwent pet-ct and thoracotomy for nsclc. Patients with clinical N2 disease were excluded. An ft was defined as any of a benign lesion; an exploratory thoracotomy; pathologic N2 or N3, stage iiib or iv, or inoperable T3 or T4 disease; and recurrence or death within 1 year of surgery. Results Of the 108 patients who met the inclusion criteria, ft occurred in 27. The main reason for ft was recurrence within 1 year (14 patients) and pathologic N2 disease (10 patients). On multivariate analysis, an Eastern Cooperative Oncology Group performance status greater than 1, a pet-ct positive N1 status, a primary tumour larger than 3 cm, and a period of more than 16 weeks from pet-ct to surgery were associated with ft. N2 disease that had been negative on pet-ct occurred in 21% of patients with a pet-ct positive N1 status and in 20% of patients with tumours larger than 3 cm and non-biopsy mediastinal staging only. The combination of pet-ct positive N1 status and a primary larger than 3 cm had 85% specificity, and the presence of either risk factor had 100% sensitivity, for ft attributable to N2 disease. Conclusions To reduce ft attributable to N2 disease, tissue biopsy for mediastinal staging should be considered for patients with pet-ct positive N1 status and with tumours larger than 3 cm even with a pet-ct negative mediastinum.

【 授权许可】

Unknown