这项研究的目的是探讨18例术前F-氟脱氧葡萄糖PET/CT淋巴结阴性肺腺癌患者隐匿性纵隔淋巴结转移(MLNM)的预测因素。
我们回顾了360例连续肺腺癌患者的临床数据和PET/CT参数,这些患者计划进行解剖性肺切除术和全身纵隔淋巴结清扫。淋巴结转移在病理上确定,所有切除的肿瘤根据2011年IASLC/ATS/ERS分类进行分类。进行单因素和多因素分析以评估临床病理变量与MLNM之间的关联。
在所有360名患者中,54例(15.0%)有病理N2病。血清CEA水平,结节类型,肺门淋巴结SUVmax,肿瘤SUVmax,尺寸,在单因素分析中,位置和组织学亚型与MLNM显著相关.在多变量分析中,CEA≥5.0ng/mL(P<0.001),实性结节(P=0.012),肿瘤SUVmax≥3.7(P<0.027),肺门淋巴结SUVmax≥2.0(P<0.001)和位于中央的肿瘤(P=0.035)是MLNM的独立危险因素。预测MLNM的肿瘤SUVmax和肺门淋巴结SUVmax的ROC曲线下面积(AUC)分别为0.764和0.730,并且五个因素的组合使用产生了0.885的更高的AUC。
原发肿瘤和肺门淋巴结SUVmax增加,实性结节,位于中央的肿瘤和CEA水平升高可预测纵隔淋巴结转移的风险增加。这些因素的结合使用提高了术前预测N2疾病的诊断能力。有这些危险因素的患者应考虑侵入性纵隔分期。即使是那些在PET/CT上纵隔阴性的患者。
The aim of this study was to investigate predictive factors of occult mediastinal lymph node metastasis (MLNM) in preoperative 18 F-fluorodeoxy-glucose PET/CT node-negative lung adenocarcinoma patients.
We reviewed the clinical data and PET/CT parameters of 360 consecutive pulmonary adenocarcinoma patients who were scheduled to undergo anatomical pulmonary resection and systemic mediastinal node dissection. The nodal metastasis was pathologically defined and all resected tumors were classified according to the 2011 IASLC/ATS/ERS classification. Univariate and multivariate analysis were conducted to evaluate the associations between clinicopathological variables and MLNM.
Of all 360 patients, 54 (15.0%) had pathological N2 diseases. The serum CEA level, nodule type, hilar nodal SUVmax, tumor SUVmax, size, location and histologic subtype were associated with MLNM significantly on univariate analysis. On multivariate analysis, CEA ≥ 5.0 ng/mL (P < 0.001), solid nodule (P = 0.012), tumor SUVmax ≥ 3.7 (P < 0.027), hilar nodal SUVmax ≥ 2.0 (P < 0.001) and centrally located tumor (P = 0.035) were independent risk factors for MLNM. The area under the ROC curve (AUC) for tumor SUVmax and hilar nodal SUVmax in predicting MLNM was 0.764 and 0.730, respectively, and the combined use of five factors yielded a higher AUC of 0.885.
Increased primary tumor and hilar lymph node SUVmax, solid nodule, centrally located tumor and increased CEA level predicted the increased risk of mediastinal lymph node metastasis. Combined use of these factors improved the diagnostic capacity for predicting N2 disease preoperatively. Invasive mediastinal staging should be considered for patients with these risk factors, even those with a negative mediastinum on PET/CT.