Optimising treatment in local and regional lung cancer
As patients with node-negative early lung cancer might be ideal candidates for sublobar resection, predictors of pathological node-negative disease were investigated in a cohort of patients with clinical stage IA NSCLC . These included 502 patients with adenocarcinoma and 100 with squamous cell carcinoma from four institutions. The relationship between lymph node status and preoperative factors, such as tumour size according to high-resolution computed tomography (HRCT) and the maximum standardised uptake value (SUVmax) on fluorodeoxyglucose positron emission tomography (FDG-PET/CT), was examined. In the adenocarcinoma cohort, SUVmax on FDG-PET/CT and tumour size on HRCT may be useful to predict node-negative stage IA lung cancer. When solid tumour size was < 0.8 cm or SUVmax was < 1.5 (N0 criteria), approximately 50 % of patients with stage cT1 disease had no affected lymph nodes (Table). Sublobar resection was shown to be feasible in stage IA tumours that meet N0 criteria, as relapse-free survival and overall survival (OS) did not differ between patients treated with lobectomy or sublobar resection. For patients with squamous-cell carcinoma, no independent predictive factors for lymph node metastasis were identified. In particular, tumour size on HRCT and SUVmax on FDG-PET/CT were not predictive of lymph node status in IA carcinoma.