Staging of early-stage lung cancer without routine PET in candidates for segmentectomy.

Introduction: We aimed to investigate the accuracy of clinical staging without the routine use of PET/CT in cIA1 and cIA2 NSCLC scheduled for segmentectomy.

Methods: 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method. Logistic regression was performed to investigate factors independently associated with pathologic upstaging.

Results: UICC-upstaging was found in 86 patients (28%). Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, p= 0.009), a higher number of lymph nodes removed (17 ± 10 vs. 13 ± 8, p= 0.001), and a higher rate of L1 involvement (34% vs. 16%, p< 0.001) than non-upstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, p= 0.031), higher rates of R1 (9% vs. 1%, p= 0.006) and L1 (39% vs. 20%, p< 0.026) than patients without nodal involvement. The 3-year and 5-year overall survival rates for upstaged and non-upstaged patients were 67% and 54%, and 85% and 67%, respectively (p = 0.040). In logistic regression L1 involvement (OR 2.394, p= 0.005) and the number of dissected lymph nodes (OR 1.037, p= 0.016) were independently associated with upstaging. Patients who received PET as part of clinical staging did not have significantly lower nodal upstaging.

Conclusions: Selective use of PET/CT based on the results of computed tomography may be a viable option for patients with proven or suspected NSCLC up to 2 cm.