Survival Outcomes and Risk Fctors of Occult N2 lymph Node Metastasis in NSCLC Patients with Clinical N0-1 Diagnosed by Preoperative PET-CT

박기성, 배지훈, 안욱수

Department of Thoracic and Cardiovascular Surgery, Catholic University of Daegu School of Medicine, Korea.

Background : Accurate staging of NSCLC for N2 lymph node metastasis is crucial for prognosis and optimal therapy. Suggestion of occult mediastinal lymph node metastasis could help physicians for decision making of staging and management. This study was aimed to know risk factors and survival for occult N2 lymph node metastasis in NSCLC patients with clinical N0 and N1 diagnosed by preoperative PET-CT.

Methods : This study was evaluated NSCLC patients with clinical N0-1 who underwent R0 lung resection with complete lymphadenectomy.

Results : Between November 2005 to December 2013, the incidence of N2 lymph node metastasis was 14.3%(21 patients of 147). The risk factors for pN2 were central located tumor(p<0.001), positive N1 nodes on PET(p<0.001), and high SUV on PET(p=0.004). Multivariate analysis identified central located tumor, and positive N1 nodes on PET. Patients having even one of risk factors had shorter survival than none, significantly(p=0.001). The overall 2- and 5-year survival rates were 57.4% and 28.7% in pN2, 89.0% and 68.3% in pN0-1, respectively(p<0.001). Median follow-up was 37.2 months.

Conclusion : The central located tumor, positive N1 nodes on PET, and high SUV of primary tumor were predictable factors for N2 lymph node metastasis in clinical N0-1 NSCLC.
The survival of patients without risk factors was better than that with risk factors.
Therefore, these factors may help determine whether to enforce cN0-1 patients on PET-CT to do mediastinal staging for favorable prognosis selectively.

책임저자: 박기성

Daegu Catholic University Medical Center

연락처 : 박기성, Tel: 053-650-4567 , E-mail : kspark69@cu.ac.kr