Skip to main content

Advertisement

SpringerLink
Log in

Lung cancer with PET/CT-defined occult nodal metastasis yields favourable prognosis and benefits from adjuvant therapy: a multicentre study

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To investigate the surgical prognosis and efficacy of adjuvant therapy in non-small cell lung cancer (NSCLC) with occult lymph node metastasis (ONM) defined by positron emission tomography/computed tomography (PET/CT).

Methods

A total of 3537 NSCLC patients receiving surgical resection were included in this study. The prognosis between patients with ONM and evident nodal metastasis, ONM patients with and without adjuvant therapy was compared, respectively.

Results

ONM was associated with significantly better prognosis than evident nodal metastasis whether for patients with N1 (5-year OS: 56.8% versus 52.3%, adjusted p value = 0.267; 5-year RFS: 44.7% versus 33.2%, adjusted p value = 0.031) or N2 metastasis (5-year OS: 42.8% versus 32.3%, adjusted p value = 0.010; 5-year RFS: 31.3% versus 21.6%, adjusted p value = 0.025). In ONM population, patients receiving adjuvant therapy yielded better prognosis comparing to those without adjuvant therapy (5-year OS: 50.1% versus 33.5%, adjusted p value < 0.001; 5-year RFS: 38.4% versus 22.1%, adjusted p value < 0.001).

Conclusions

ONM defined by PET/CT identifies a unique clinical subtype of lung cancer, ONM is a favorable prognostic factor whether for pathological N1 or N2 NSCLC and adjuvant therapy could provide additional survival benefits for ONM patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11:39–51. https://doi.org/10.1016/j.jtho.2015.09.009.

    Article  PubMed  Google Scholar 

  2. National Comprehensive Cancer Network. (NCCN) Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer, Version 7. 2021. https://www.nccn.org/professionals/physician_gls/default.aspx. Accessed 29 Oct 2021.

  3. Preoperative chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual participant data. Lancet (London, England). 2014;383:1561-71. https://doi.org/10.1016/s0140-6736(13)62159-5.

  4. Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350:351–60. https://doi.org/10.1056/NEJMoa031644.

    Article  PubMed  Google Scholar 

  5. Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJ, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26:3552–9. https://doi.org/10.1200/jco.2007.13.9030.

    Article  PubMed  Google Scholar 

  6. Scagliotti GV, Pastorino U, Vansteenkiste JF, Spaggiari L, Facciolo F, Orlowski TM, et al. Randomized phase III study of surgery alone or surgery plus preoperative cisplatin and gemcitabine in stages IB to IIIA non-small-cell lung cancer. J Clin Oncol. 2012;30:172–8. https://doi.org/10.1200/jco.2010.33.7089.

    Article  CAS  PubMed  Google Scholar 

  7. Song WA, Zhou NK, Wang W, Chu XY, Liang CY, Tian XD, et al. Survival benefit of neoadjuvant chemotherapy in non-small cell lung cancer: an updated meta-analysis of 13 randomized control trials. J Thorac Oncol. 2010;5:510–6. https://doi.org/10.1097/JTO.0b013e3181cd3345.

    Article  PubMed  Google Scholar 

  8. Uy KL, Darling G, Xu W, Yi QL, De Perrot M, Pierre AF, et al. Improved results of induction chemoradiation before surgical intervention for selected patients with stage IIIA-N2 non-small cell lung cancer. J Thorac Cardiovasc Surg. 2007;134:188–93. https://doi.org/10.1016/j.jtcvs.2007.01.078.

    Article  PubMed  Google Scholar 

  9. Chen Z, Xiong S, Li J, Ou L, Li C, Tao J, et al. DNA methylation markers that correlate with occult lymph node metastases of non-small cell lung cancer and a preliminary prediction model. Transl Lung Cancer Res. 2020;9:280–7. https://doi.org/10.21037/tlcr.2020.03.13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Vaghjiani RG, Takahashi Y, Eguchi T, Lu S, Kameda K, Tano Z, et al. Tumor Spread Through Air Spaces Is a Predictor of Occult Lymph Node Metastasis in Clinical Stage IA Lung Adenocarcinoma. J Thorac Oncol. 2020;15:792–802. https://doi.org/10.1016/j.jtho.2020.01.008.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Martini N, Flehinger BJ, Zaman MB, Beattie EJ Jr. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Surg. 1983;198:386–97. https://doi.org/10.1097/00000658-198309000-00015.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Andre F, Grunenwald D, Pignon JP, Dujon A, Pujol JL, Brichon PY, et al. Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol. 2000;18:2981–9. https://doi.org/10.1200/jco.2000.18.16.2981.

    Article  CAS  PubMed  Google Scholar 

  13. Kim MP, Correa AM, Hofstetter WL, Mehran RJ, Rice DC, Roth JA, et al. Occult stage IIIA-N2 patients have excellent overall survival with initial surgery. J Thorac Dis. 2018;10:6670–6. https://doi.org/10.21037/jtd.2018.10.94.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yang CF, Kumar A, Gulack BC, Mulvihill MS, Hartwig MG, Wang X, et al. Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis. J Thorac Cardiovasc Surg. 2016;151:1380–8. https://doi.org/10.1016/j.jtcvs.2015.12.028.

    Article  PubMed  Google Scholar 

  15. Kim HK, Choi YS, Kim K, Shim YM, Park K, Ahn YC, et al. Outcomes of mediastinoscopy and surgery with or without neoadjuvant therapy in patients with non-small cell lung cancer who are N2 negative on positron emission tomography and computed tomography. J Thorac Oncol. 2011;6:336–42. https://doi.org/10.1097/JTO.0b013e318201212e.

    Article  PubMed  Google Scholar 

  16. Whitson BA, Groth SS, Maddaus MA. Recommendations for optimal use of imaging studies to clinically stage mediastinal lymph nodes in non-small-cell lung cancer patients. Lung cancer (Amsterdam, Netherlands). 2008;61:177–85. https://doi.org/10.1016/j.lungcan.2007.12.019.

    Article  Google Scholar 

  17. Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg. 2008;86:362–6; discussion 6–7. https://doi.org/10.1016/j.athoracsur.2008.04.042.

Download references

Funding

Supported by the National Natural Science Foundation of China (91959126, 8210071009), Science and Technology Commission of Shanghai Municipality (20XD1403000, 21YF1438200), Shanghai Municipal Health Commission (201940018), Shanghai Hospital Development Center (SHDC2020CR3047B), and Clinical Research Foundation of Shanghai Pulmonary Hospital (FK1943, FK1937).

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200443, China

    Jiajun Deng, Yifan Zhong, Yunlang She & Chang Chen

  2. Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China

    Tingting Wang

  3. Department of Thoracic Surgery, Hwa Mei Hospital, Chinese Academy of Sciences, Zhejiang, China

    Minglei Yang

  4. Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo City, Zhejiang, China

    Minglei Yang

  5. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China

    Minjie Ma & Chang Chen

  6. The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China

    Minjie Ma & Chang Chen

  7. Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China

    Yongxiang Song

Authors
  1. Jiajun Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yifan Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tingting Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minglei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Minjie Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yongxiang Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yunlang She
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the MultiomIcs claSSIfier for pulmOnary Nodules (MISSION) Collaborative Group

Contributions

Yifan Zhong, Jiajun Deng, Yunlang She and Chang Chen contributed to the concept and design of the study. Minglei Yang, Minjie Ma and Yongxiang Song were responsible for acquiring the data. Tingting Wang performed data analysis and statistical analysis. Yifan Zhong and Jiajun Deng drafted the manuscript. Yunlang She and Chang Chen critically reviewed and approved the manuscript. The authors are on behalf of the MultiomIcs claSSIfier for pulmOnary Nodules (MISSION) Collaborative Group.

Corresponding authors

Correspondence to Yunlang She or Chang Chen.

Ethics declarations

Ethics approval

Institutional Review Board of Shanghai Pulmonary Hospital, Ningbo No. 2 Hospital, The First Hospital of Lanzhou University and Affiliated Hospital of Zunyi Medical College approved this research.

Consent to participate

Waiver of written informed consent was obtained for this retrospective research.

Consent for publication

All authors agreed publication.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Oncology - Chest

J Deng and Y Zhong contributed equally to this work; Y She and C Chen are co-corresponding authors.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deng, J., Zhong, Y., Wang, T. et al. Lung cancer with PET/CT-defined occult nodal metastasis yields favourable prognosis and benefits from adjuvant therapy: a multicentre study. Eur J Nucl Med Mol Imaging 49, 2414–2424 (2022). https://doi.org/10.1007/s00259-022-05690-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-022-05690-3

Keywords

Search

Navigation