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Clinical impact and utility of positron emission tomography on occult lymph node metastasis and survival: radical surgery for stage I lung cancer

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Abstract

Objective

The surgical result of early-staged lung cancer is not satisfactory due to unexpected postoperative lymph node metastasis and recurrence. This study aimed to investigate which preoperative factors—including the standard uptake value max (SUVmax) of positron emission tomography—could predict occult lymph node metastasis and survival.

Methods

We retrospectively analyzed data from 598 patients with clinical stage I lung cancer who underwent surgery, and examined their preoperative clinical characteristics.

Results

A total of 1586 patients had surgery for primary lung cancer between 2006 and 2019; 598 patients with clinical stage I lung cancer were the study inclusion; occult lymph node metastasis was detected in 102 (17.1%). Univariable and multivariable analyses showed that SUVmax ≥ 3 (P < 0.001), clinical invasive tumor size ≥ 2 cm (P = 0.009), and carcinoembryonic antigen > 5 (P = 0.03) were associated with significant risk factors rated (%) for occult lymph node metastasis, as follows: high-risk group (three factors), moderate-risk group (two factors) and low-risk group (one factor or none) corresponding to 32.2 (28/87), 22.8 (41/180) and 7.3 (19/262), respectively (P < 0.001). The 5-year overall survival rates (%) of patients without lymph node metastasis holding SUVmax 6 or over were as poor as those of patients with lymph node metastasis (72.0% vs 64.1%; P = 0.56).

Conclusions

We might consider wedge resection or segmentectomy, omitting lymphadenectomy, for the low-risk group; adjuvant therapy is indicated for patients without lymph node metastasis having SUVmax 6 or over.

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Acknowledgments

We are very grateful to Enago for English proofreading.

Funding

This study received no funding from any institutions.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan

    Haruaki Hino, Takahiro Utsumi, Natsumi Maru, Hiroshi Matsui, Yohei Taniguchi, Tomohito Saito & Tomohiro Murakawa

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  1. Haruaki Hino
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  2. Takahiro Utsumi
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  3. Natsumi Maru
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  4. Hiroshi Matsui
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Correspondence to Haruaki Hino.

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Hino, H., Utsumi, T., Maru, N. et al. Clinical impact and utility of positron emission tomography on occult lymph node metastasis and survival: radical surgery for stage I lung cancer. Gen Thorac Cardiovasc Surg 69, 1196–1203 (2021). https://doi.org/10.1007/s11748-021-01606-4

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  • DOI: https://doi.org/10.1007/s11748-021-01606-4

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