Does High Standard Uptake Value on Positron Emission Tomography Preclude Sublobar Resection in Stage IA Non-Small Cell Lung Cancer ≤2 cm?

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2024-11-14 DOI:10.1016/j.athoracsur.2024.11.007

Shaikha Al-Thani MD , Abu Nasar MSc , Jonathan Villena-Vargas MD , Oliver Chow MD , Sebron Harrison MD , Benjamin Lee MD , Nasser Altorki MD , Jeffrey Port MD

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Abstract

Background

Recent randomized trials have shown equivalent survival after sublobar resection vs lobectomy in patients with clinical stage IA non-small cell lung cancer (NSCLC) ≤2 cm. High maximum standard uptake value (SUVmax) is a known risk factor in NSCLC, yet limited data exist on whether a high SUV should preclude a sublobar resection. This study aimed to determine whether there is an association between SUVmax and survival based on the extent of parenchymal resection.

Methods

A retrospective review of a prospectively maintained institutional database was conducted to identify patients with clinical stage IA NSCLC ≤2 cm (2011-2020) treated with sublobar resection or lobectomy. The primary outcome was cancer-specific survival (CSS). Secondary outcomes were overall survival and disease-free survival.

Results

There were 543 patients identified; 36.8% had sublobar resection and 63.2% had lobectomy. Baseline characteristics were similar. Patients who had sublobar resection had significantly worse Eastern Cooperative Oncology Group performance status and higher rates of comorbidities. The 5-year CSS, overall survival, and disease-free survival for the whole cohort were similar between sublobar resection and lobectomy. A receiver operating characteristic curve estimated the SUVmax cutoff point to be 4.15. For the whole cohort, patients with SUVmax >4.15 had worse CSS compared with SUVmax ≤4.15. However, there was no significant difference in 5-year CSS after sublobar resection vs lobectomy in patients with SUVmax ≤4.15 (98% in both groups; P = .77) or patients with SUVmax >4.15 (90% vs 94%, respectively; P = .12).

Conclusions

SUVmax may not be a useful clinical determinant of the extent of parenchymal resection in patients with cT1 N0 NSCLC ≤2 cm. Patients treated by sublobar resection had comparable survival to lobectomy, irrespective of positron emission tomography avidity.

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对于≤2 厘米的 IA 期非小细胞肺癌，正电子发射断层扫描的高标准摄取值是否排除了叶下切除术？

背景：最近的随机试验显示，对于临床分期为IA期、≤2厘米的非小细胞肺癌（NSCLC）患者，肺叶切除术（SLR）与肺叶切除术后的生存率相当。高 SUVmax 是 NSCLC 的一个已知风险因素，但关于高 SUV 是否应排除 SLR 的数据却很有限。本研究旨在根据实质切除范围确定SUVmax与生存率之间是否存在关联：方法：对前瞻性维护的机构数据库进行回顾性审查，以确定接受 SLR 或肺叶切除术治疗的临床 IA 期 NSCLC≤2cm 患者（2011-2020 年）。主要结果是癌症特异性生存率（CSS）。次要结果为总生存期（OS）和无病生存期（DFS）：共确定了 543 名患者，其中 36.8% 接受了 SLR，63.2% 接受了肺叶切除术。基线特征相似。接受SLR的患者ECOG表现状态明显较差，合并症发生率较高。SLR和肺叶切除术的5年CSS、OS和DFS相似。根据接收者操作特征曲线估计，SUVmax 临界点为 4.15。在整个队列中，SUVmax>4.15的患者与SUVmax≤4.15的患者相比，CSS较差。然而，SUVmax≤4.15（两组均为98%；P=0.77）或SUVmax>4.15（分别为90%对94%；P=0.12）的患者在SLR与肺叶切除术后的5年CSS无明显差异：SUVmax可能不是决定cT1N0 NSCLC≤2cm患者实质切除范围的有用临床因素。无论 PET 反应阳性与否，接受 SLR 治疗的患者的生存率与肺叶切除术相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.