Lung Cancer

PV 01 - Poster Viewing Q&A - Session 1

SU_22_3134 - Occult Hilar and Mediastinal Nodal Disease for Clinical Early Stage, Node-Negative Non-small Cell Lung Cancer Staged with PET-CT

Sunday, September 15
1:15 PM - 2:30 PM
Location: ASTRO Innovation Hub

Occult Hilar and Mediastinal Nodal Disease for Clinical Early Stage, Node-Negative Non-small Cell Lung Cancer Staged with PET-CT
N. Agrawal1, D. Hause1, S. Freije1, P. Forys2, H. Burney3, Y. Zang3, J. Hinton1, and T. Lautenschlaeger1; 1Indiana University Department of Radiation Oncology, Indianapolis, IN, 2Indiana University Department of Pulmonary Medicine, Indianapolis, IN, 3Indiana University Department of Biostatistics, Indianapolis, IN

Purpose/Objective(s): The aim of this study was to identify clinicopathologic factors that predict for occult hilar and mediastinal adenopathy in patients diagnosed with clinical stage I/II, node-negative non-small cell lung cancer (NSCLC) staged with PET-CT, with the goal to identify a subset of patients who may require additional work-up to identify nodal metastases prior to definitive treatment.

Materials/Methods: Of 5754 patients with lung cancer treated at a single institution between 2008 – 2016 identified from a cancer registry, 143 were included who had NSCLC, staged with PET-CT as clinically node negative, and underwent surgical resection of the primary along with nodal sampling. Patients were excluded if PET-CT read was unavailable, pre-operative invasive nodal evaluation was performed, and if they had metastatic disease or prior cancer history. Patients were grouped as pathologically node negative (N=103) or pathologically node positive (N=40). Cox proportional hazards model was used for univariate and multivariate analysis, with all factors significant at p<0.1 included in the multivariate analysis. A propensity score analysis was performed on patients matched 1:1 for age, tumor diameter, tumor location, max SUV of primary and histology.

Results: For the entire cohort of 143 patients, the median age was 65 (34-83), and 60 (42%) were never-smokers. Adenocarcinoma and squamous histology were found in 61.5% and 33.6% of patients, respectively. One-hundred fourteen (78%) had a peripheral tumor, with median diameter of 2.3 cm (0.9-8.2 cm). Fifty-six (39%), 26% and 27% were staged as clinical T1a, T1b and T2a, respectively. Thirty-two (22%) and 6% were diagnosed with pathological N1 and N2 disease, respectively. Thirty-seven (26%) had LVSI and 22% had visceral-pleural invasion (VPI). On univariate analysis, higher clinical tumor stage (p=0.01), tumor size (p=0.02), central tumor location (p=0.03), higher pathological tumor stage (p=0.008), presence of LVSI (p<0.0001) and VPI (p=0.02) significantly correlated with occult nodal metastases. On multivariate analysis, higher pathological T stage (p=0.0015) and LVSI (p<0.0001) correlated with occult nodal metastases. Thirty-nine pairs were analyzed after matching for age, tumor diameter, tumor location, max SUV of primary and histology. Clinical tumor stage (p=0.04) and LVSI (p<0.0001) correlated with occult nodal metastases on multivariate analysis.

Conclusion: Tumor stage (AJCC 7th edition T1b and higher) and LVSI predict for occult hilar and mediastinal nodal metastases in patients diagnosed with node negative NSCLC on PET-CT. This data suggests that it is important to identify a pre-surgical correlate with LVSI. These patients should undergo additional nodal evaluation prior to definitive therapy as they may be upstaged, with vast prognostic and treatment implications.

Author Disclosure: N. Agrawal: None. D. Hause: None. S. Freije: None. Y. Zang: None. T. Lautenschlaeger: None.

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SU_22_3134 - Occult Hilar and Mediastinal Nodal Disease for Clinical Early Stage, Node-Negative Non-small Cell Lung Cancer Staged with PET-CT



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