Development of indication criteria for preoperative examination in lung cancer. (May 2017)

• Record Type: Journal Article
• Authors: Nakao, Masayuki; Matsuura, Yosuke; Uehara, Hirofumi; Mun, Mingyon; Nakagawa, Ken; Nishio, Makoto; Ishikawa, Yuichi; Okumura, Sakae
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 25:Number 4(2017)
• Page Start: 281
• Page End: 286
• Publication Date: 2017-05
• Subjects: Carcinoma -- non-small-cell lung -- Lymphatic metastasis -- Neoplasm staging -- Tomography -- X-ray computed; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492317709698
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: Systemic examination for distant metastases is generally recommended for all lung cancer patients. However, this approach rarely detects distant metastases in typically resectable cT1-2N0 non-small-cell lung cancer. The aim of this study was to identify factors associated with distant metastases and develop indication criteria for preoperative systemic examination in patients with cT1-2N0 non-small-cell lung cancer, with a particular focus on computed tomography imaging of primary lesions. Methods: We retrospectively reviewed non-small-cell lung cancer patients treated at our institute between 2005 and 2013. Data were extracted and compared between two groups: patients diagnosed as cT1-2N0M0 who underwent complete resection (M0 group, n = 1530) and those diagnosed as cT1-2N0M1b who received systemic chemotherapy (M1 group, n = 26). Results: The median age at diagnosis was significantly lower in the M1 group ( p = 0.015). Although carcinoembryonic antigen levels were significantly higher in the M1 group ( p < 0.001), 42% had normal levels. Tumor diameters in lung and mediastinal windows on chest computed tomography were significantly larger, and the proportion (mediastinal/lung window tumor diameter ratio) was higher in the M1 group ( p < 0.001). All 26 patients in the M1 group had a tumor diameter >15 mm and mediastinal/lung window ratio >0.75. Conclusions: Preoperative systemic examination is not necessary in cT1-2N0 non-small-cell lung cancer patients when tumor diameters are ≤15 mm and mediastinal/lung window ratios are ≤0.75. According to these criteria, systemic examinations would have been reduced by 40% in our cohort.