Abstract
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. 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. 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. 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.
Highlights
IntroductionNon-small-cell lung cancer (nsclc) accounts for most lung cancers (85%), and optimal treatment depends on the stage of the disease
Lung cancer is the leading cause of cancer death in both men and women[1]
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
Summary
Non-small-cell lung cancer (nsclc) accounts for most lung cancers (85%), and optimal treatment depends on the stage of the disease. An estimated 40% of newly diagnosed nsclc patients present with stage iv disease, and palliative-intent treatment with chemotherapy or radiotherapy is indicated[2]. Earlier-stage disease is amenable to potentially curative treatment. For stage i and ii nsclc, surgical resection is the treatment of choice[3], but in the presence of mediastinal nodal metastases, definitive chemoradiotherapy or induction therapy followed by surgery are indicated[4,5,6,7]. An additional objective of accurate staging is to avoid inappropriate treatments: for example, noncurative lung resection [“futile thoracotomy” (ft)] in the context of a falsely negative mediastinum, or denial of potentially curative surgery because of a false-positive finding[8]. We sought to identify preoperative risk factors for ft in patients staged with pet-ct
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