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Predictive Factors for Mediastinal Lymph Node Metastases in Patients with Non-small Cell Lung Cancer, as Detected by Video-assisted Mediastinoscopic Lymphadenectomy.
СтатьяНазвание и аннотация: Перевод в очереди
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Herrmann Dominik, Ewig Santiago, Christoph Daniel Christian, Bas Kaya Tugba, Greif Katharina, Milobinski Kolja, Oggiano Melanie, Walles Thorsten, Welter Stefan, Hecker Erich
Аннотация
PURPOSE: Accurate mediastinal staging of non-small cell lung cancer is essential for guiding curative treatment strategies, particularly regarding the indication for neoadjuvant therapy. This study evaluated pretherapeutic predictive factors for mediastinal lymph node metastases based on routinely collected clinico-pathological data.
PATIENTS AND METHODS: We retrospectively analysed data from all patients who underwent video-assisted mediastinoscopic lymphadenectomy for mediastinal staging before curatively-intended treatment during a 12-year period. Logistic regression and ROC analyses were used to identify independent risk factors for histologically confirmed N2/N3 involvement.
RESULTS: Clinical N2 status based on PET/CT was the strongest independent predictor of mediastinal metastasis. However, even patients with cN1 status showed a significantly increased risk. Adenocarcinoma histology (OR 2.3; p < 0.01) and central tumour location (OR 2.1; p < 0.01) were also independently associated with mediastinal involvement. ROC analysis identified a tumour size ≥ 3 cm as a potential cutoff, although discrimination was limited (AUC 0.588).
CONCLUSION: Mediastinal lymph node involvement in NSCLC is not restricted to patients with abnormal PET/CT findings. Central tumours, adenocarcinoma or lesions > 3 cm should undergo invasive staging, regardless of imaging appearance.
PATIENTS AND METHODS: We retrospectively analysed data from all patients who underwent video-assisted mediastinoscopic lymphadenectomy for mediastinal staging before curatively-intended treatment during a 12-year period. Logistic regression and ROC analyses were used to identify independent risk factors for histologically confirmed N2/N3 involvement.
RESULTS: Clinical N2 status based on PET/CT was the strongest independent predictor of mediastinal metastasis. However, even patients with cN1 status showed a significantly increased risk. Adenocarcinoma histology (OR 2.3; p < 0.01) and central tumour location (OR 2.1; p < 0.01) were also independently associated with mediastinal involvement. ROC analysis identified a tumour size ≥ 3 cm as a potential cutoff, although discrimination was limited (AUC 0.588).
CONCLUSION: Mediastinal lymph node involvement in NSCLC is not restricted to patients with abnormal PET/CT findings. Central tumours, adenocarcinoma or lesions > 3 cm should undergo invasive staging, regardless of imaging appearance.